Template

NIKKIS OSHBOX Incident Record Form 2021

by Angie Williams, from the Community

10+

This incident record form from NIKKIS OSHBOX helps teams document near misses, injuries, illnesses, and notifiable events. Capture key details including dates, locations, people involved, nature of injury, property damage, treatment, and witness statements. Add photos, note analysis and root causes, and record corrective and preventive actions. Includes sections for management review, hazard register updates, toolbox meetings, and WorkSafe notification guidance.

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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
NIKKIS OSHBOX Incident Investigation Form
This incident investigation form guides managers and health and safety representatives through documenting an incident from start to finish. Capture incident date, location, conditions, sequence of events, photos, and nature of injury. Record injured person details, treatment, and whether testing occurred. Identify immediate and underlying causes across location, equipment, procedures, people, hazard identification and controls, training, competence, supervision, governance, and standards such as PPE. Include witness details, medical treatment, and prevention steps with owners and due dates. Track notification to WorkSafe, investigation timestamps, and risk register updates. Close the investigation only after due diligence and full implementation of corrective actions by an Officer or PCBU.
by Angie Williams, from the Community
Downloads: 10+
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Template
TWOW Incident Record 2024
This incident record template helps teams document near misses, injuries, and illnesses in detail. Capture what happened, where and when, the people involved, nature of injury, onsite treatment, witness details, and property damage. Include analysis of contributing factors, corrective and preventive actions, and management review. Guidance prompts support regulatory notifications and follow up activities such as toolbox meetings and hazard register updates, making it ideal for construction and other high risk worksites.
by Angie Williams, from the Community
Downloads: 0
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Template
Incident Report Form - SideShift
Use this SideShift incident report form to document workplace injuries, property damage, near misses, and work-related illnesses. Capture incident details, time and place, people involved, witness statements, emergency response, and treatment provided. Record PPE usage, corrective actions, and supervisor notification to support investigations and compliance. Ideal for construction sites and field teams using SafetyCulture.
by SIDESHIFT OFFICE, from the Community
Downloads: 0
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Template
Incident Notification and Investigation Report
This incident notification and investigation report template helps teams document injuries, illnesses, near misses, and equipment or vehicle damage. Capture initial details, locations, dates, and people involved; classify severity and OSHA recordability; add photos; identify contributing factors; and assess potential severity and recurrence. Plan corrective actions with owners and due dates, and collect required signatures. Appendices cover injury details, body parts and nature of injury, and vehicle or equipment damage, plus employee and witness statements.
by Devon Patchin, from the Community
Downloads: 30+
Get

NIKKIS OSHBOX Incident Investigation Form

This incident investigation form guides managers and health and safety representatives through documenting an incident from start to finish. Capture incident date, location, conditions, sequence of events, photos, and nature of injury. Record injured person details, treatment, and whether testing occurred. Identify immediate and underlying causes across location, equipment, procedures, people, hazard identification and controls, training, competence, supervision, governance, and standards such as PPE. Include witness details, medical treatment, and prevention steps with owners and due dates. Track notification to WorkSafe, investigation timestamps, and risk register updates. Close the investigation only after due diligence and full implementation of corrective actions by an Officer or PCBU.

by Angie Williams, from the Community

10+

Get

Template

TWOW Incident Record 2024

This incident record template helps teams document near misses, injuries, and illnesses in detail. Capture what happened, where and when, the people involved, nature of injury, onsite treatment, witness details, and property damage. Include analysis of contributing factors, corrective and preventive actions, and management review. Guidance prompts support regulatory notifications and follow up activities such as toolbox meetings and hazard register updates, making it ideal for construction and other high risk worksites.

by Angie Williams, from the Community

Get

Template

Incident Report Form - SideShift

Use this SideShift incident report form to document workplace injuries, property damage, near misses, and work-related illnesses. Capture incident details, time and place, people involved, witness statements, emergency response, and treatment provided. Record PPE usage, corrective actions, and supervisor notification to support investigations and compliance. Ideal for construction sites and field teams using SafetyCulture.

by SIDESHIFT OFFICE, from the Community

Get

Template

Incident Notification and Investigation Report

This incident notification and investigation report template helps teams document injuries, illnesses, near misses, and equipment or vehicle damage. Capture initial details, locations, dates, and people involved; classify severity and OSHA recordability; add photos; identify contributing factors; and assess potential severity and recurrence. Plan corrective actions with owners and due dates, and collect required signatures. Appendices cover injury details, body parts and nature of injury, and vehicle or equipment damage, plus employee and witness statements.

by Devon Patchin, from the Community

30+

Get

NIKKIS OSHBOX Incident Record Form 2021

About author

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NIKKIS OSHBOX Incident Investigation Form

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NIKKIS OSHBOX Incident Investigation Form

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