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Template

Incident, Accident/Collision, Injury, and Near Miss Report

by Greg Key, from the Community

Downloads: 20+
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Use this incident report template to document accidents, collisions, injuries, near misses, and fatalities on the job. Capture employee and incident details, worksite location, cause, body part affected, police report and citation info, witness contacts, and treating medical facility. Record PPE use, hours worked, contributing factors, and whether more training is needed. Include supervisor notes, corrective actions, and return-to-work information. Designed for timely reporting within four hours to support compliance, investigations, and prevention across field and construction operations.

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

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.