Template

Adverse Event Report Template

by Paul McConnell, from the Community

This adverse event report template helps teams document workplace incidents comprehensively. Capture incident details, weather conditions, and parties involved, including witness statements and signatures. Record injury types, affected body parts, and medical attention provided. Log evidence, equipment, vehicles, and damages. Perform root cause analysis, assess likelihood of recurrence, and define corrective actions. Includes tiered management sign-offs and meeting records to review controls, ensure accountability, and support regulatory compliance, including RIDDOR-aligned severity levels.

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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.

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A comprehensive incident reporting and investigation system designed to document workplace incidents, accidents, injuries, and near-misses. The form covers essential details including incident type, severity assessment, weather conditions, involved parties, injury documentation, and evidence collection. It features a structured approach to root cause analysis, corrective actions, and multiple management review levels. The system includes detailed sections for recording witness statements, medical attention provided, equipment involved, and damage assessment. A thorough sign-off process ensures proper review by tier one and tier two management, with additional protocols for serious incidents requiring Senior Management Team or Managing Director involvement. The form emphasizes factual documentation and includes provisions for photos, evidence logging, and follow-up actions to prevent future occurrences.
by Paul McConnell, from the Community
Downloads: 40+
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Adverse Event Report Template

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