Template

Incident/Injury Report Form

by Christina Edlaine De Jesus, from the Community

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.

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 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
SafetyCulture Incident and Injury Report Form
Use this customizable Incident and Injury Report Form to record workplace accidents, injuries, and near misses. Capture personal and incident details, witness information, injury specifics, and time lost. Includes an investigation checklist covering contributing factors, equipment condition, environment, PPE, surface types, and manual handling. WHS managers can add findings and assign corrective actions using the hierarchy of controls, with owners and due dates. Ideal for workshops and industrial sites, and adaptable across industries to improve safety and compliance.
by Darryl Bancale, from the Community
Downloads: 20+
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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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Template
Incident and Injury Report Form Template
This Incident and Injury Report Form helps teams record and investigate workplace accidents quickly and consistently. The template guides users to capture essential details such as incident time and location, parties involved, injury specifics, contributing factors, equipment condition, PPE use, and manual handling elements. It includes prompts for WHS Manager and Supervisor notifications, investigator observations, and corrective actions across elimination, substitution, administration, and PPE controls. Ideal for workshops and general operations, it supports thorough WHS investigations, consistent reporting, and faster follow-up. Customizable within SafetyCulture.
by Roger Mercado, from the Community
Downloads: 30+
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Incident/Injury Report Form

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