Template

Incident, Injury, Near Miss Report and Investigation Form

by InFocus Safety Solutions, Inc., from the Community

20+

Use this incident, injury, and near miss report and investigation form to document what happened, capture injured person details, witnesses, causes, treatment, machinery involved, immediate actions, photos, and corrective improvements. Suitable for construction, steel fabrication, and industrial operations to support EHS compliance and continuous safety improvement.

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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

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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
Injury, Accident, Incident and Near Miss Report
Use this comprehensive incident reporting template to capture key details after any workplace injury, accident, incident, or near miss. Record staff involved, date, time, location, witnesses, and notifications. Document injuries and treatment, police involvement and tests, property or vehicle damage, and attach photos. Analyze immediate causes and contributing factors, assess potential severity and likelihood of recurrence, and define corrective actions with responsible persons. Include third party details and insurance information to support follow up and compliance.
by Warren Ellison, from the Community
Downloads: 0
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Template
Vindex Systems Incident and Near Miss Report Form
Use this incident and near miss report form to capture essential details after an event on site. Sections include site and job information, person involved, employment status (employee, subcontractor, public), PPE and site induction checks, event date, location, and narrative. Rate severity including near miss, minor, medium, or major injury (RIDDOR), document corrective actions, and record signatures and consent. Designed to streamline reporting and support safety and compliance reviews.
by Mark Fenton, from the Community
Downloads: 10+
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Template
Accident, Incident and Near Miss Investigation Report
Use this accident, incident and near miss investigation report template to document events clearly and consistently. Record incident details, injured persons and witnesses, companies involved, and any plant or equipment. Capture root cause analysis, corrective actions and immediate controls. Includes evidence gathering guidance for inductions, RAMS, permits, lift plans, competence certificates, statements, images and short video. Supports RIDDOR reporting and potential insurance or compensation claims, including service strike checks and construction site requirements.
by Shaun Jones, from the Community
Downloads: 0
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Template
Incident Report Form
Document and attach photos for injury/ illness, near miss, property damage, hazard, risk.
by SafetyCulture
Downloads: 4,000+
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Injury, Accident, Incident and Near Miss Report

Use this comprehensive incident reporting template to capture key details after any workplace injury, accident, incident, or near miss. Record staff involved, date, time, location, witnesses, and notifications. Document injuries and treatment, police involvement and tests, property or vehicle damage, and attach photos. Analyze immediate causes and contributing factors, assess potential severity and likelihood of recurrence, and define corrective actions with responsible persons. Include third party details and insurance information to support follow up and compliance.

by Warren Ellison, from the Community

Get

Template

Vindex Systems Incident and Near Miss Report Form

Use this incident and near miss report form to capture essential details after an event on site. Sections include site and job information, person involved, employment status (employee, subcontractor, public), PPE and site induction checks, event date, location, and narrative. Rate severity including near miss, minor, medium, or major injury (RIDDOR), document corrective actions, and record signatures and consent. Designed to streamline reporting and support safety and compliance reviews.

by Mark Fenton, from the Community

10+

Get

Template

Accident, Incident and Near Miss Investigation Report

Use this accident, incident and near miss investigation report template to document events clearly and consistently. Record incident details, injured persons and witnesses, companies involved, and any plant or equipment. Capture root cause analysis, corrective actions and immediate controls. Includes evidence gathering guidance for inductions, RAMS, permits, lift plans, competence certificates, statements, images and short video. Supports RIDDOR reporting and potential insurance or compensation claims, including service strike checks and construction site requirements.

by Shaun Jones, from the Community

Get