Template

Supervisor's Accident Report

by Aaron Martin, from the Community

This Supervisor's Accident Report template helps supervisors document workplace incidents thoroughly. Capture what the employee was doing, the injury type and body part, PPE used, equipment involved, hazardous materials, root causes, prevention steps, witnesses, and off-site treatment details, then complete the supervisor signature. Use this as a starting point and adapt it to your worksite and jurisdiction.

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Digitize any process, procedure or policy

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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 Report Form
Use this accident report form to document incidents that result in injury or damage. Record the date, time, location, people involved, work being performed, and witnesses. Capture photos of the scene and affected body part or area, and describe what happened before, during, and after the event. Note protection measures in place such as permits, briefings, barriers, and PPE, then identify immediate and root causes. Log medical treatment and who provided it, and outline environmental controls if applicable. Add corrective actions with assignees, priority, and due dates, and complete the report with employee, supervisor, and manager signatures for compliance.
by Thomasina Larkin, from the Community
Downloads: 10+
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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
Accident/Injury Incident Report Template
This accident and injury incident report template helps teams document workplace incidents thoroughly. Capture incident type, hazard source, specific body part injured, and the activity being performed at the time. Record employee and witness statements, first aid administered, whether off-site medical treatment was required, and who assisted. Track required PPE and safety procedures (e.g., LOTO, machine safeguards), note if they were used, and explain deviations. Identify contributing factors such as equipment, job procedures, layout, time pressure, lack of PPE or training, and outline corrective and preventive actions with responsible parties. Includes validation and sign-off fields for employee, supervisor, safety coordinator, and investigation team members.
by Jason Madsen, from the Community
Downloads: 40+
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Template
Accident / Incident Initial Investigation Report
Use this Accident / Incident Initial Investigation Report template to quickly document workplace accidents and near misses. Capture core details including what happened, who was involved, date and location, incident type and severity, injuries or damage, witnesses, supervisor, and equipment involved. Record contributing factors, PPE in use, worker competency and training, emergency response, and immediate controls. Add recommendations to reduce risk, note if further investigation is required, and collect signatures. This general template is provided as a starting point and should be reviewed for suitability to your operations and jurisdiction.
by Steve Harker, from the Community
Downloads: 0
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Accident Report Form

Use this accident report form to document incidents that result in injury or damage. Record the date, time, location, people involved, work being performed, and witnesses. Capture photos of the scene and affected body part or area, and describe what happened before, during, and after the event. Note protection measures in place such as permits, briefings, barriers, and PPE, then identify immediate and root causes. Log medical treatment and who provided it, and outline environmental controls if applicable. Add corrective actions with assignees, priority, and due dates, and complete the report with employee, supervisor, and manager signatures for compliance.

by Thomasina Larkin, from the Community

10+

Get

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

10+

Get

Template

Accident/Injury Incident Report Template

This accident and injury incident report template helps teams document workplace incidents thoroughly. Capture incident type, hazard source, specific body part injured, and the activity being performed at the time. Record employee and witness statements, first aid administered, whether off-site medical treatment was required, and who assisted. Track required PPE and safety procedures (e.g., LOTO, machine safeguards), note if they were used, and explain deviations. Identify contributing factors such as equipment, job procedures, layout, time pressure, lack of PPE or training, and outline corrective and preventive actions with responsible parties. Includes validation and sign-off fields for employee, supervisor, safety coordinator, and investigation team members.

by Jason Madsen, from the Community

40+

Get

Template

Accident / Incident Initial Investigation Report

Use this Accident / Incident Initial Investigation Report template to quickly document workplace accidents and near misses. Capture core details including what happened, who was involved, date and location, incident type and severity, injuries or damage, witnesses, supervisor, and equipment involved. Record contributing factors, PPE in use, worker competency and training, emergency response, and immediate controls. Add recommendations to reduce risk, note if further investigation is required, and collect signatures. This general template is provided as a starting point and should be reviewed for suitability to your operations and jurisdiction.

by Steve Harker, from the Community

Get

Supervisor's Accident Report

About author

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