Template

Incident and Injury Investigation

by Dave Renje, from the Community

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.

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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 Investigation Form
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.
by Tyler Bonzo, from the Community
Downloads: 0
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Template
Motor Mall Incident Report Full Investigation
Use this incident investigation report template to document incidents from first notification through root cause. Record incident details, timelines, environmental conditions, evidence and attachments, vehicle and equipment logs, damages, and people involved. Capture statements, injury types and body parts affected, and medical treatment. Perform root cause analysis, note contributing factors, and add corrective actions. Finish with sign off and follow up to close out the investigation.
by Liam Daniels, from the Community
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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
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Template
Incident Investigation Report Template
This comprehensive incident investigation report template helps teams capture the facts, evidence, and outcomes of workplace incidents from start to finish. Record incident details and timelines, document weather conditions, log evidence with photos, and track vehicles, equipment, damages, and other items. Capture people involved, witness statements and signatures, and detailed injury information including type and affected body parts. Conduct a structured root cause analysis using contributing factors and five whys to identify underlying causes and likelihood of recurrence. Plan and verify corrective actions and recommendations, then finalize with investigator and reviewer sign-offs and follow-up assignments. Ideal for construction and field operations seeking a thorough, repeatable approach to incident documentation and prevention.
by Mark Baylis, from the Community
Downloads: 10+
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Incident Investigation Form

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.

by Tyler Bonzo, from the Community

Get

Template

Motor Mall Incident Report Full Investigation

Use this incident investigation report template to document incidents from first notification through root cause. Record incident details, timelines, environmental conditions, evidence and attachments, vehicle and equipment logs, damages, and people involved. Capture statements, injury types and body parts affected, and medical treatment. Perform root cause analysis, note contributing factors, and add corrective actions. Finish with sign off and follow up to close out the investigation.

by Liam Daniels, from the Community

Get

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

Get

Template

Incident Investigation Report Template

This comprehensive incident investigation report template helps teams capture the facts, evidence, and outcomes of workplace incidents from start to finish. Record incident details and timelines, document weather conditions, log evidence with photos, and track vehicles, equipment, damages, and other items. Capture people involved, witness statements and signatures, and detailed injury information including type and affected body parts. Conduct a structured root cause analysis using contributing factors and five whys to identify underlying causes and likelihood of recurrence. Plan and verify corrective actions and recommendations, then finalize with investigator and reviewer sign-offs and follow-up assignments. Ideal for construction and field operations seeking a thorough, repeatable approach to incident documentation and prevention.

by Mark Baylis, from the Community

10+

Get

Incident and Injury Investigation

About author

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Incident Investigation Form

Motor Mall Incident Report Full Investigation

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Incident Investigation Report Template

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Incident Investigation Form

Motor Mall Incident Report Full Investigation

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