Template

Serious Incident / Accident Reporting Form

by Wendy Worters, from the Community

Use this serious incident and accident reporting form to document workplace incidents, injuries, near misses, and abuse events. Capture key details such as dates, location, people involved, incident type, injury description, and immediate actions taken. Support investigations with root cause analysis, corrective actions, assigned owners, and closure dates. Includes fields for first aid, medical attention, Worksafe notifications, hazard register updates, and sign-offs by safety managers and leadership.

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
Minor Accident and Incident Report Form
Use this minor accident and incident report form to document workplace incidents that result in injury. Designed for supervisors and managers, it captures key details such as incident date, location, people involved, type of incident, injuries sustained, witness statements, and immediate actions taken. Dedicated sections cover plant and equipment involved, operator competence, and RIDDOR considerations. The template also includes investigator comments and signature fields to verify accuracy and support SHEQ investigations, compliance, and follow up.
by Shaun Jones, from the Community
Downloads: 0
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Template
Workplace Incident and Injury Report Form Guide
Comprehensive workplace incident reporting form template for documenting injuries, near misses, and environmental incidents. Includes risk assessment and corrective actions.
by Juan Rivera, from the Community
Downloads: 30+
Get
Template
Incident/Accident Form
Use this incident/accident form to log workplace events including near misses, first aid cases, lost time injuries, spills, and vehicle-related incidents. Capture key details such as date, location, division, department, injured person information, area affected, witness names, medical attention provided, police notification, and days lost. Standardize reporting to support EHS compliance, root-cause analysis, and trend tracking across teams and sites. Ideal for supervisors and safety managers seeking consistent documentation and faster follow-up.
by David Guerra, from the Community
Downloads: 0
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Template
Accident Investigation Form - WorkSafe NZ
Use this WorkSafe New Zealand accident investigation form to document workplace incidents in detail. Capture site and personnel information, date and time, injuries and affected body parts, damaged property, and a description of what happened. Record immediate treatment, first aid and medical care, contributing factors, severity and likelihood, and corrective actions with owners and due dates. Include drawings or media, investigator details, and whether WorkSafe has been advised. Ideal for standardizing incident reporting and supporting root cause analysis.
by john smith, from the Community
Downloads: 10+
Get

Minor Accident and Incident Report Form

Use this minor accident and incident report form to document workplace incidents that result in injury. Designed for supervisors and managers, it captures key details such as incident date, location, people involved, type of incident, injuries sustained, witness statements, and immediate actions taken. Dedicated sections cover plant and equipment involved, operator competence, and RIDDOR considerations. The template also includes investigator comments and signature fields to verify accuracy and support SHEQ investigations, compliance, and follow up.

by Shaun Jones, from the Community

Get

Template

Workplace Incident and Injury Report Form Guide

Comprehensive workplace incident reporting form template for documenting injuries, near misses, and environmental incidents. Includes risk assessment and corrective actions.

by Juan Rivera, from the Community

30+

Get

Template

Incident/Accident Form

Use this incident/accident form to log workplace events including near misses, first aid cases, lost time injuries, spills, and vehicle-related incidents. Capture key details such as date, location, division, department, injured person information, area affected, witness names, medical attention provided, police notification, and days lost. Standardize reporting to support EHS compliance, root-cause analysis, and trend tracking across teams and sites. Ideal for supervisors and safety managers seeking consistent documentation and faster follow-up.

by David Guerra, from the Community

Get

Template

Accident Investigation Form - WorkSafe NZ

Use this WorkSafe New Zealand accident investigation form to document workplace incidents in detail. Capture site and personnel information, date and time, injuries and affected body parts, damaged property, and a description of what happened. Record immediate treatment, first aid and medical care, contributing factors, severity and likelihood, and corrective actions with owners and due dates. Include drawings or media, investigator details, and whether WorkSafe has been advised. Ideal for standardizing incident reporting and supporting root cause analysis.

by john smith, from the Community

10+

Get

Serious Incident / Accident Reporting Form

About author

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Minor Accident and Incident Report Form

Workplace Incident and Injury Report Form Guide

Incident/Accident Form

Accident Investigation Form - WorkSafe NZ

You might also like

Minor Accident and Incident Report Form

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Accident Investigation Form - WorkSafe NZ