Ultimate Incident Report Form Template for Workplace Safety

A well-designed incident report form is critical for a comprehensive and effective incident management process. By capturing core information, it enables teams to implement corrective actions, conduct thorough investigations, and prevent future incidents. Our incident report template can be customized for various scenarios, including workplace injury, property damage, environmental incidents, and near-misses.

Essential Fields for Your Incident Report Form

Here's a breakdown of the essential categories and fields that provide a complete picture of any incident.

1. Initial Incident Information
This section is for capturing the basic facts of the event. Key fields include:

Date, Time & Location: The exact time and place of the incident.
Personnel & Reporting: The name and position of the person logging the incident, who it was reported to, and whether they were a witness.
Detailed Description: A narrative of what happened, what the person was doing, and any factors that led to the incident.
Immediate Actions: A record of any immediate steps taken and whether further action is required.

2. Incident details
This section dives into the specifics, especially for workplace injury reporting.

Incident Severity & Lost Time: Categorize the incident's impact, including any lost work time.
Injured Person's Information: Name, role, employment status, and demographic details.
Injury Specifics: A detailed record of the body part injured, mechanism of injury, and nature of injury.
Initial Treatment: Information on the immediate medical care provided.

3. Notification & Escalation
This final category addresses the required level of reporting.

Notifiable Incident: Fields to determine if the incident needs to be escalated to regulatory bodies.
Police & Other Reports: A record of whether a police report was made and any other required notifications.

Example Incident Report Form

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TRY CREATING YOUR OWN INCIDENT REPORT FORM

Ready to create a professional incident report form? Use our intuitive incident report form builder and template library. You can either select and customize a pre-built template or build your own form from scratch to perfectly match your organization's needs. Try it out and see how easy it is to improve your incident reporting process!

INCIDENT REPORT FORM TEMPLATE

Ultimate Incident Report Form Template for Workplace Safety

Essential Fields for Your Incident Report Form

Example Incident Report Form

TRY CREATING YOUR OWN INCIDENT REPORT FORM