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.
With SafetyCulture you can
Digitize team workflows
Turn your workflows into digital templates or checklists so your team can conduct inspections efficiently and access them from any device.
Reduce manual errors
Help your team complete tasks more accurately with digital templates that minimize errors from manual processes.
Create and share inspection reports
Generate inspection reports and share them with your team and stakeholders to keep everyone informed.
About author
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.