Template

Incident Investigation Form

by Tyler Bonzo, from the Community

This incident investigation form helps supervisors and managers document workplace incidents the same day they occur. Capture incident type, department, location, date and time, witness details, and photos. Assess injury details including body part affected and nature of injury or illness. Identify causal and basic causes, perform a 5 Why root cause analysis, and note immediate corrective actions. Record OSHA classification, property damage, near misses, and high-potential events to support compliance and continuous improvement.

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Eliminate mistakes made by paper-based processes

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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.

Template
Injury Investigation Form Template
Use this injury investigation form to document a first report of injury or illness. Capture employee and incident details including date, time, location, injury type, and body part affected; eyewitness information; environmental conditions; underlying factors such as PPE use, equipment issues, and training gaps; and recommended corrective actions. Attach photos or media, assign actions, and record investigator and supervisor sign-off. Suitable for construction and other industries to support incident reporting and root cause analysis.
by Jonathan Nixon, from the Community
Downloads: 0
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Template
Incident and Injury Investigation
Use this incident and injury investigation form to capture key incident details, determine root causes, and implement corrective actions. The checklist guides you from reporting and first aid through evidence gathering, cause analysis, and action planning, then evaluates effectiveness for continuous improvement. Ideal for supervisors and safety teams seeking a consistent, defensible process to reduce repeat incidents and improve workplace safety.
by Dave Renje, from the Community
Downloads: 0
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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+
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Template
Incident and Investigation Report
Use this Incident and Investigation Report template to capture critical WHS details after an event. Record incident type, location, dates, injured or ill persons, treatment, injury descriptions, dangerous events, electrical and environmental incidents, near misses, and property or vehicle damage. Collect evidence, witness statements, and photos, then complete investigation steps including PEEPO analysis, contributing factors, root cause, and corrective actions. Includes management notifications, sign-offs, and communication plans to support compliance with Work Health and Safety requirements and consistent reporting across teams.
by Angela Warren, from the Community
Downloads: 10+
Get

Injury Investigation Form Template

Use this injury investigation form to document a first report of injury or illness. Capture employee and incident details including date, time, location, injury type, and body part affected; eyewitness information; environmental conditions; underlying factors such as PPE use, equipment issues, and training gaps; and recommended corrective actions. Attach photos or media, assign actions, and record investigator and supervisor sign-off. Suitable for construction and other industries to support incident reporting and root cause analysis.

by Jonathan Nixon, from the Community

Get

Template

Incident and Injury Investigation

Use this incident and injury investigation form to capture key incident details, determine root causes, and implement corrective actions. The checklist guides you from reporting and first aid through evidence gathering, cause analysis, and action planning, then evaluates effectiveness for continuous improvement. Ideal for supervisors and safety teams seeking a consistent, defensible process to reduce repeat incidents and improve workplace safety.

by Dave Renje, from the Community

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

10+

Get

Template

Incident and Investigation Report

Use this Incident and Investigation Report template to capture critical WHS details after an event. Record incident type, location, dates, injured or ill persons, treatment, injury descriptions, dangerous events, electrical and environmental incidents, near misses, and property or vehicle damage. Collect evidence, witness statements, and photos, then complete investigation steps including PEEPO analysis, contributing factors, root cause, and corrective actions. Includes management notifications, sign-offs, and communication plans to support compliance with Work Health and Safety requirements and consistent reporting across teams.

by Angela Warren, from the Community

10+

Get

Incident Investigation Form

About author

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Injury Investigation Form Template

Incident and Injury Investigation

Incident Injury Report Form Template

Incident and Investigation Report

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Injury Investigation Form Template

Incident and Injury Investigation

Incident Injury Report Form Template

Incident and Investigation Report