Template

Incident Report Form Template

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Use this incident report form template to document and investigate workplace incidents and injuries. Capture personal and incident details, type of injury, affected body parts, medical treatment, time lost, and a clear description of how the incident happened. Record contributing factors such as environment, equipment condition, housekeeping, surface type, footwear, and manual handling. Include photos, notes, and corrective actions with assignees, priorities, and due dates. Sections for WHS manager comments and recommendations support elimination, substitution, engineering, administration, and PPE controls. Complete with digital signatures and export to PDF, Word, Excel, or web link.

With SafetyCulture you can

Digitize team workflows

Turn your workflows into digital templates or checklists so your team can conduct inspections efficiently and access them from any device.

Reduce manual errors

Help your team complete tasks more accurately with digital templates that minimize errors from manual processes.

Create and share inspection reports

Generate inspection reports and share them with your team and stakeholders to keep everyone informed.

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SafetyCulture

Free 1,000+ Workplace Checklists & Templates created by the SafetyCulture team.

Template
Incident/Injury Report Form
Use this Incident/Injury Report Form to document workplace events quickly and accurately. Capture personal and incident details, supervisor and WHS manager notifications, injury type and affected body part, treatment and time lost, and a full investigation checklist. Record contributing factors, equipment and PPE used, surface and environment conditions, manual handling actions, and preventive measures. Close the loop with corrective actions using the hierarchy of controls (elimination, substitution, engineering, administration, PPE), assign owners and due dates, and track recommendations to completion. Ideal for WHS compliance across industrial and field environments.
by Christina Edlaine De Jesus, from the Community
Downloads: 0
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Template
Incident Injury Report Form Template
Use this Incident Injury Report Form to document workplace accidents and near misses. Record personal and incident details, witness information, injury type and body part affected, contributing factors, and site conditions. Includes an investigation checklist, risk controls (elimination, substitution, engineering, administration, PPE), and action tracking to prevent recurrence and improve WHS compliance.
by John Patrick Agustin, from the Community
Downloads: 10+
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Template
Incident and Injury Report Form Template
This Incident and Injury Report Form helps teams record and investigate workplace accidents quickly and consistently. The template guides users to capture essential details such as incident time and location, parties involved, injury specifics, contributing factors, equipment condition, PPE use, and manual handling elements. It includes prompts for WHS Manager and Supervisor notifications, investigator observations, and corrective actions across elimination, substitution, administration, and PPE controls. Ideal for workshops and general operations, it supports thorough WHS investigations, consistent reporting, and faster follow-up. Customizable within SafetyCulture.
by Roger Mercado, from the Community
Downloads: 30+
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Template
SafetyCulture Incident and Injury Report Form
Use this customizable Incident and Injury Report Form to record workplace accidents, injuries, and near misses. Capture personal and incident details, witness information, injury specifics, and time lost. Includes an investigation checklist covering contributing factors, equipment condition, environment, PPE, surface types, and manual handling. WHS managers can add findings and assign corrective actions using the hierarchy of controls, with owners and due dates. Ideal for workshops and industrial sites, and adaptable across industries to improve safety and compliance.
by Darryl Bancale, from the Community
Downloads: 20+
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Incident Report Form Template

With SafetyCulture you can

Digitize team workflows

Reduce manual errors

Create and share inspection reports

About author

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Incident/Injury Report Form

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