Template

Accident Report Form

by Thomasina Larkin, from the Community

10+

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.

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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

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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
EVOLVE Accident Report Form
Use this EVOLVE accident report form template to document workplace incidents clearly and consistently. Record department, injured person and job title, date and time, and accident location. Describe the task being performed, injuries sustained, how the incident occurred, and any immediate actions such as first aid or stopping work. Capture witness names, equipment involved with ID, applicable safe working procedures such as standard operating procedures or COSHH, PPE in use, worker competence and training, and environmental conditions. Note any absence from work, outline recommendations to reduce risk, and record supervisor details. Complete sign off, indicate if further investigation is required, and attach the file to the health and safety report log.
by Kriss Nash, from the Community
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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
Supervisor's Accident Report
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.
by Aaron Martin, from the Community
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Template
Accident and Incident Report Template
This workplace accident and incident report template helps teams capture essential details after an event. Record date, time, location, witnesses, and specific area; describe injuries and any first aid or medical treatment; document property or vehicle damage with photos; note environmental conditions and immediate causes such as slips, trips, and falls. Include analysis of contributing factors, corrective actions with responsible persons, potential severity, what could have happened, and probability of recurrence. Add signatures to confirm accuracy. Intended as a starting point only—customize for your organization and seek professional advice for compliance.
by alex copland, from the Community
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Accident Report Form

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EVOLVE Accident Report Form

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EVOLVE Accident Report Form

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