Template

Incident and Hazard Report Form

by Pooja Prasad, from the Community

Use this incident and hazard report form to document events and hazards in the workplace. Capture reporter details, location, incident or hazard type, and a clear description. Record injury information including injured person, contact, nature and location of injury, and treatment provided. Assess risk using consequence and likelihood to determine overall risk level. Identify contributing factors such as inadequate equipment, procedures, supervision, or training, and define corrective actions with control type, due dates, and assignees. Route the report to the right person and capture signatures to close out the report.

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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

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
Incident / Hazard Report Form
Use this hazard report form to: - Identify the incident / hazard type and the level of treatment needed - Record who was injured, their contact number, and the nature of the injury - Document the task/s performed when the incident / injury occurred - Check which factors contributed to the hazard, incident, and/or injury - Specify the control type when creating corrective actions
by SafetyCulture
Downloads: 100+
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Template
Incident, Injury, Near Miss, Environmental Report Form
This incident report form helps teams document injuries, near misses, hazards, and any property or environmental damage that occurs on site. It captures key details including person and witness information, incident description, injury and treatment details, immediate and basic causes, contributing factors, and recommended corrective actions. The form also includes a structured risk assessment with consequence and likelihood ratings, plus manager sign-off and reporting fields for LTI and MTI. Use it to standardize workplace incident reporting and drive timely corrective action.
by Juan Rivera, from the Community
Downloads: 10+
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Template
Incident/Injury Report Form
Use this Incident/Injury Report Form to document workplace events quickly and accurately. Capture personal and incident details, supervisor and WHS manager notifications, injury type and affected body part, treatment and time lost, and a full investigation checklist. Record contributing factors, equipment and PPE used, surface and environment conditions, manual handling actions, and preventive measures. Close the loop with corrective actions using the hierarchy of controls (elimination, substitution, engineering, administration, PPE), assign owners and due dates, and track recommendations to completion. Ideal for WHS compliance across industrial and field environments.
by Christina Edlaine De Jesus, from the Community
Downloads: 0
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Template
Incident Report Form Template
Use this incident report form template to document and investigate workplace incidents and injuries. Capture personal and incident details, type of injury, affected body parts, medical treatment, time lost, and a clear description of how the incident happened. Record contributing factors such as environment, equipment condition, housekeeping, surface type, footwear, and manual handling. Include photos, notes, and corrective actions with assignees, priorities, and due dates. Sections for WHS manager comments and recommendations support elimination, substitution, engineering, administration, and PPE controls. Complete with digital signatures and export to PDF, Word, Excel, or web link.
by SafetyCulture
Downloads: 300+
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Incident and Hazard Report Form

About author

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