Incident, Injury, Near Miss, Environmental Report Form
by Juan Rivera, from the Community
This incident report form helps teams document injuries, near misses, hazards, and any property or environmental damage that occurs on site. It captures key details including person and witness information, incident description, injury and treatment details, immediate and basic causes, contributing factors, and recommended corrective actions. The form also includes a structured risk assessment with consequence and likelihood ratings, plus manager sign-off and reporting fields for LTI and MTI. Use it to standardize workplace incident reporting and drive timely corrective action.
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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.