Template

PFM Accident Report Form

by Eric Zabinski, from the Community

10+

This PFM accident report form helps teams record customer and employee incidents in a consistent way. Capture incident date, time, location, names, witness details, injury descriptions, affected body areas, and type of injury. Document causes, equipment involved, and exposure. Complete an investigation with contributing factors and vehicle or slip and fall details. Plan corrective actions such as training, housekeeping, or equipment changes, and track policy violations and disciplinary steps to improve safety and compliance.

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
Accident Investigation Form
This accident investigation form helps construction teams document workplace incidents thoroughly and consistently. Record incident details, location, date and time, weather conditions, and photos. Capture involved employee information, witness details, and training status. Verify JHA availability and compliance, note pre-task checklist completion, and identify causes, contributing factors, and any safety violations. Summarize findings and assign corrective actions with responsible persons, due dates, and signatures. Designed to support root cause analysis and continuous improvement across job sites.
by Joe Schemonia, from the Community
Downloads: 0
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Template
Accident Incident Report Template
Use this accident and incident report template to document workplace events from initial details to investigation. Record employee and site information, date and time, injury and body part, witnesses, medical treatment, severity and return to work status. Capture causes and contributing factors, corrective actions with responsible parties and due dates, and lessons learned. Include employee and witness statements and attach photos, drawings and training records to support the report.
by Steve Pope, from the Community
Downloads: 10+
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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 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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PFM Accident Report Form

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Accident Investigation Form

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