Template

Incident Investigation Form Template

by Jamie Mallinder, from the Community

10+

This incident investigation form helps teams document and analyze workplace events to prevent recurrence. Capture the injured person’s details, body location, mechanism and agency of injury, and a clear description of events. Conduct a structured worker interview, assess inherent risk using a matrix, and review alignment with initial reports. Analyze causal factors across People, Environment, Equipment, Process, and Organization to identify the primary cause. Prioritize controls following the hierarchy of hazard elimination, substitution, isolation, engineering, administrative measures, and PPE, then assign corrective actions.

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

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/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
Get
Template
Cromwell Incident and Investigation Report Form
This Cromwell Incident and Investigation Report Form helps teams record workplace incidents from initial details through closeout. Capture person and incident information, injuries and affected body parts, mechanism of injury, and work location. Document witnesses, treatment provided, photos or CCTV, and potential workers’ compensation. Assess risk using a matrix, analyze contributing factors across unsafe acts, conditions, and system deficiencies, and document root causes. Assign and track corrective actions, then rate residual risk. Include approvals and signatures to formally complete the investigation.
by Rod Martin, from the Community
Downloads: 10+
Get
Template
Incident Injury Report Form Template
Use this Incident Injury Report Form to document workplace accidents and near misses. Record personal and incident details, witness information, injury type and body part affected, contributing factors, and site conditions. Includes an investigation checklist, risk controls (elimination, substitution, engineering, administration, PPE), and action tracking to prevent recurrence and improve WHS compliance.
by John Patrick Agustin, from the Community
Downloads: 10+
Get
Template
Injury Investigation - Initial
This initial injury investigation checklist helps supervisors document incident details, identify contributing factors, and define corrective actions to prevent recurrence. Capture worker information, time and location, injury type and body part, treatment, witnesses, and site conditions. Evaluate equipment, environment, human factors, methods, and PPE. Attach photos, record inspection findings, and assign responsible persons with due dates. Includes supervisor sign-off and health and safety manager comments.
by Rick Haertel, from the Community
Downloads: 0
Get

Incident Investigation Form Template

About author

You might also like

Incident/Injury Report Form

Cromwell Incident and Investigation Report Form

Incident Injury Report Form Template

Injury Investigation - Initial

You might also like

Incident/Injury Report Form

Cromwell Incident and Investigation Report Form

Incident Injury Report Form Template

Injury Investigation - Initial