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.