The best way of recording body part hurt is to have a diagram of a person which you circle to show the affected body part(s).

If the purpose of the template is to help you to gather statistics, then starting with an example template is the wrong way round.  Instead you need to identify what statistics will be useful for you to gather and then design the template to suit that.

First you have to ask what you want the statistics for.

Gathering statistics because the information is what happens to be on your template is not a good reason for gathering those statistics.

What use do you hope to make of the statistics?

As Kate says you design the template around what data you want(or need to collect). There is no point collecting loads of information that you will simply discard. You also need to make sure that you are collecting what you need. For example you are interested in injury location data. Collecting that makes sense if you a) have a reasonably  large sized workforce- no point doing it if consists of a dozen people who you know individually b) they re all doing a similar job eg working on production line or building site. What you are trying to identify  is a pattern, where people are having accidents and injuries affecting same parts the body. If everybody is doing very different tasks, then it becomes obvious that injury patterns relate to different tasks. you also need to be careful about any personal data capture. At one place I worked at they used standard template which asked whether an incident was related to drugs or alcohol consumption. This might be an issue in some sectors but in that area it simply created a lot bad feelings and so I removed it from the template.