Safety Forms
Year End Injury Summary Form
A full calendar year of personal injury statistics - lost time cases, medical referrals, days lost, frequency, and severity, month by month - laid out as one running grid, delivered as a real fillable PDF.
- Fillable PDF — type into it on any device, or print it blank
- Single page, 11" x 8.5" (Letter, landscape)
- Add your company logo at checkout — no extra charge
- Written by Canadian safety professionals to provincial OHS standards
- Instant download after purchase
Written by certified COR auditors · Trusted by Canadian contractors for 17+ years · Secure Stripe checkout · Instant delivery + re-download any time from your purchases page
Pairs with online training
Certificates issue instantly through our online training portal.
TWELVE MONTHS OF INJURY DATA, ON ONE PAGE, READY FOR A CERTIFYING PARTNER
What you get
- A fillable PDF - all 65 monthly and total data cells are real form fields
- A 13-row grid (January through December, plus a Total row) already labelled, so nothing is renamed or reordered by hand
- Five statistic columns per month: Lost Time Cases, Medical Referral, Days Lost, Frequency, and Severity
- A Year field at the top so a saved copy is dated at a glance
- A management sign-off line confirming the year-end numbers
- Your company logo added to the form, at no extra charge
How to fill it out and keep it. Open it in Adobe Acrobat Reader (free) or a desktop browser like Chrome or Edge, then use that program's own Save or Download button, not just closing the tab, so your entries are kept in the saved copy. On a phone, most PDF apps will let you view the form but not type into it - fill it out on a computer, or print it and use a pen.
Specifications
- Size
- 11" x 8.5" (Letter, landscape)
- Format
- Fillable PDF - type into it on any device, or print it blank
- Company logo
- Included - upload at checkout, or we print your company name instead
- Delivery
- Instant download after purchase
Why crews use it
- Every month sits on the same page as every other month, so a frequency or severity trend across the year is visible without flipping between twelve separate monthly reports
- The Total row does the same math a certifying partner or insurer will ask for, already labelled and positioned exactly where they'll expect to find it
- Landscape layout gives each of the five statistics its own full column, wide enough for real numbers instead of a cramped multi-line cell
- Supports the year-end injury statistics reporting COR/SECOR certifying partners and WCB/workers' compensation programs commonly require
Built for
- Safety managers compiling year-end statistics for ownership, a board, or a certifying partner
- Companies preparing COR/SECOR audit evidence that needs a full-year injury statistics summary
- Contractors submitting annual injury frequency and severity rates to a client or prequalification platform
Why it matters
Injury frequency and severity are trend numbers - a single month's count means little on its own, but twelve months side by side show whether the program is actually improving. Keeping the whole year on one page is what makes that comparison possible without reconstructing it from twelve separate monthly reports after the fact.
Try it right here
Click a box. Type a line. See how it feels before you buy.
This is the real form layout - what you type here isn't saved or sent anywhere, it's just so you can see the fields work before you pay.
Common questions
Before you buy
What people ask us about the Year End Injury Summary Form.
What is the Year End Injury Summary Form used for?
Year End Injury Summary Form for Canadian worksites. Professionally designed, print-ready format. Supports compliance with provincial OHS regulations. Delivered in both formats - an editable Word file to add your company name and customise for your worksite, plus a print-ready PDF. All required fields, signature lines, and dates included. Written by Canadian safety professionals. Instant download after purchase. It is written for Canadian workplaces and formatted so it can go straight into your safety program.
Is it editable, or print-ready only?
It is supplied in an editable format, so you can add your company name, adjust the wording to match how your crews actually work, and issue it under your own program.
Does using this form make us compliant?
No single form makes a company compliant. A form is the evidence half of a safety program - it records that something was checked and by whom. It carries weight at audit time when the written program behind it says the check is required and how often. If that program does not exist yet, that is the part we write.
What format is it, and when do I get it?
It is a digital download available immediately after checkout, and you can print as many copies as your own crews need.
From the team that wrote it
These forms come from a bigger program.
Inspection and competency forms are the evidence half of a safety program. If the program they belong to does not exist yet, or has not been updated in a few years, that is the part we write.