Template

Accident Investigation Form - WorkSafe NZ

by john smith, from the Community

10+

Use this WorkSafe New Zealand accident investigation form to document workplace incidents in detail. Capture site and personnel information, date and time, injuries and affected body parts, damaged property, and a description of what happened. Record immediate treatment, first aid and medical care, contributing factors, severity and likelihood, and corrective actions with owners and due dates. Include drawings or media, investigator details, and whether WorkSafe has been advised. Ideal for standardizing incident reporting and supporting root cause analysis.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Accident Investigation Form - Worksafe NZ
Created by WorkSafe New Zealand, this accident investigation form can be used to record details of an incident as part of an investigation.
by SafetyCulture
Downloads: 15,000+
Get
Template
DGC Accident Investigation Template
Streamline post-incident reporting with this customizable DGC accident investigation checklist. Capture injured person details, injury type and body part, property damage, and witness statements. Document incident description, root cause analysis, severity and likelihood, and treatment provided. Record doctor or hospital details, note WorkSafe notification, and add photos. Assign corrective and preventive actions with recommendations, and finalize with investigator details and report date. Designed for New Zealand workplaces and adaptable to construction operations.
by Bruce Mason, from the Community
Downloads: 20+
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Template
Franklin Smith Incident Report and Investigation Form
Document workplace incidents with a structured form that captures site, date and time, people involved, injuries or damage, and a clear description of events. Identify key contributing factors across environment, human factors, equipment, and methods. Apply the 5 Whys to determine root cause, review supporting documents, and record corrective actions with owners and due dates. Includes a WorkSafe NZ notifiable event prompt.
by SafetyCulture
Downloads: 0
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Template
Serious Incident / Accident Reporting Form
Use this serious incident and accident reporting form to document workplace incidents, injuries, near misses, and abuse events. Capture key details such as dates, location, people involved, incident type, injury description, and immediate actions taken. Support investigations with root cause analysis, corrective actions, assigned owners, and closure dates. Includes fields for first aid, medical attention, Worksafe notifications, hazard register updates, and sign-offs by safety managers and leadership.
by Wendy Worters, from the Community
Downloads: 0
Get

Accident Investigation Form - Worksafe NZ

Created by WorkSafe New Zealand, this accident investigation form can be used to record details of an incident as part of an investigation.

by SafetyCulture

15,000+

Get

Template

DGC Accident Investigation Template

Streamline post-incident reporting with this customizable DGC accident investigation checklist. Capture injured person details, injury type and body part, property damage, and witness statements. Document incident description, root cause analysis, severity and likelihood, and treatment provided. Record doctor or hospital details, note WorkSafe notification, and add photos. Assign corrective and preventive actions with recommendations, and finalize with investigator details and report date. Designed for New Zealand workplaces and adaptable to construction operations.

by Bruce Mason, from the Community

20+

Get

Template

Franklin Smith Incident Report and Investigation Form

Document workplace incidents with a structured form that captures site, date and time, people involved, injuries or damage, and a clear description of events. Identify key contributing factors across environment, human factors, equipment, and methods. Apply the 5 Whys to determine root cause, review supporting documents, and record corrective actions with owners and due dates. Includes a WorkSafe NZ notifiable event prompt.

by SafetyCulture

Get

Template

Serious Incident / Accident Reporting Form

Use this serious incident and accident reporting form to document workplace incidents, injuries, near misses, and abuse events. Capture key details such as dates, location, people involved, incident type, injury description, and immediate actions taken. Support investigations with root cause analysis, corrective actions, assigned owners, and closure dates. Includes fields for first aid, medical attention, Worksafe notifications, hazard register updates, and sign-offs by safety managers and leadership.

by Wendy Worters, from the Community

Get

Accident Investigation Form - WorkSafe NZ

About author

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Accident Investigation Form - Worksafe NZ

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Accident Investigation Form - Worksafe NZ

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