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Template

Injury, Accident, Incident and Near Miss Report

by Warren Ellison, from the Community

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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.

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.