REPORTING SELF-INJURY

Dear [human resource manager supervisor],

I am writing to report an injury that inflicted me on [date] at around [time]. I was performing [task or activity at hand when the injury occurred] when [describe the incident that led to injury: e.g., a large box fell on my toe, I slid.]. My [body part] sustained the injury, which seems to be [severe/minimal]. Currently, I have [not sought/already sought] medical assistance for this injury.

I would like to request for the necessary forms so that I can officially report this injury.  I would be grateful for your assistance in completing these forms, given that this is my first time to have incurred a work-related injury.

I would appreciate your time and guidance.

Sincerely,

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