Template

Incident Report

by M Philippi, from the Community

10+

This CB Energy incident report template helps teams document incidents across injuries, illness, environmental events, property damage, theft, near misses, or fatalities. Record who was involved, contact details, date, time, location, and any medical treatment. Log equipment or vehicles, add photos, and capture witness statements with signatures. Support the investigation with root cause analysis, reporting to ESO/WHS, evidence of task risk assessments, training and site induction records, and attach SWMS, toolbox talks, or prestart documentation. Plan corrective and preventive actions and finalize with investigating officer sign-off.

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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
Injury, Accident, Incident and Damage Report
This incident report template helps teams capture comprehensive details for injuries, accidents, near misses, and property damage on-site. Record the incident time, location, people involved, and who it was reported to. Add witness details and statements, first aid or medical treatment, and photos of damage and environmental conditions. Document immediate causes, contributing factors, and corrective actions with responsible persons. Assess potential severity and likelihood of recurrence, include comments, and finalize with approvals and signatures to close out the report. Ideal for construction and field operations to standardize reporting and improve safety.
by Conview Team 2, from the Community
Downloads: 0
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Template
Incident and Investigation Report
Use this Incident and Investigation Report template to capture critical WHS details after an event. Record incident type, location, dates, injured or ill persons, treatment, injury descriptions, dangerous events, electrical and environmental incidents, near misses, and property or vehicle damage. Collect evidence, witness statements, and photos, then complete investigation steps including PEEPO analysis, contributing factors, root cause, and corrective actions. Includes management notifications, sign-offs, and communication plans to support compliance with Work Health and Safety requirements and consistent reporting across teams.
by Angela Warren, from the Community
Downloads: 10+
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Template
Workplace Incident Report Template
Use this workplace incident report template to document what happened, when and where it occurred, and who was involved. Capture the date and time, who the incident was reported to, and the exact location. Record supervisor details and witness names. Document those involved, the nature of any injuries, and any first aid or medical treatment. Note any property damage and attach photos. Provide a clear incident description including environmental conditions, immediate causes, and contributing factors. Assign corrective actions with responsible persons, assess potential severity and likelihood of recurrence, and finalize with date and signature. This template is a starting point and does not replace professional advice.
by Cameron Lawrence, from the Community
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Template
WAFarmers Incident Investigation Report Template
This WAFarmers incident investigation template helps teams capture complete incident details, from date, time, and location to weather conditions and a timeline of events. Log evidence, equipment, vehicles, damages, and other items with photos and IDs. Record people involved, statements, injuries, and affected body parts. Perform root cause analysis, evaluate likelihood of recurrence, and add corrective actions. Conclude with sign-off and follow-up to produce a thorough incident report.
by Trevor Whittington, from the Community
Downloads: 10+
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Incident Report

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Injury, Accident, Incident and Damage Report

Incident and Investigation Report

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Injury, Accident, Incident and Damage Report

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