Template

STS Incident Reporting Form

by Kenneth Cole, from the Community

A comprehensive incident reporting and accident investigation form tailored for job sites. Capture incident details including location, job number, dates and times, incident type, and whether emergency services responded. Record employee involvement, injury severity, body part affected, type of injury, medical treatment needs, and training status. Document witness statements, immediate corrective actions, and lessons learned. Track property damage, utility strikes, chemical spills, and vehicle incidents with driver details, vehicle information, diagrams, and photos. Include citations, drug testing status, and follow up actions to support safety compliance and continuous 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

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.

Template
Accident Incident Report Template
Use this accident and incident report template to document workplace events from initial details to investigation. Record employee and site information, date and time, injury and body part, witnesses, medical treatment, severity and return to work status. Capture causes and contributing factors, corrective actions with responsible parties and due dates, and lessons learned. Include employee and witness statements and attach photos, drawings and training records to support the report.
by Steve Pope, from the Community
Downloads: 10+
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Template
BAPKO Metal Incident and Injury Investigation
Document workplace incidents with this BAPKO Metal incident and injury investigation checklist. Capture incident details, injury type and affected body part, medical treatment, employee and witness statements, photos, and scene information. Analyze primary causes and contributing factors, then assign immediate and long-term corrective actions with owners and due dates for effective follow-up.
by Jeff Trout, from the Community
Downloads: 0
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Template
Incident Investigation Form
This incident investigation form helps supervisors and managers document workplace incidents the same day they occur. Capture incident type, department, location, date and time, witness details, and photos. Assess injury details including body part affected and nature of injury or illness. Identify causal and basic causes, perform a 5 Why root cause analysis, and note immediate corrective actions. Record OSHA classification, property damage, near misses, and high-potential events to support compliance and continuous improvement.
by Tyler Bonzo, from the Community
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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
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STS Incident Reporting Form

About author

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