Template

Warehouse Accident: Employee Report

by Derek Rainbolt, from the Community

40+

This warehouse accident report form template provides a structured format for documenting workplace incidents and accidents. The form includes essential sections for personal information, incident details, location specifics, and witness accounts. It covers various workplace areas including freezer, cooler, dry storage, dock, break room, and office spaces. The template requires detailed documentation of the incident timeline, preventive measures, and any hazardous material involvement. It also includes sections for equipment damage assessment, media documentation, and incident sketches. The form concludes with both employee and supervisor signatures, ensuring proper verification and review of the reported incident. This template serves as a crucial tool for maintaining workplace safety records and implementing preventive measures.

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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
Initial Employee Incident Report
This employee incident report form template provides a structured format for documenting workplace incidents and injuries. The form captures essential information including employee details, incident timing, location specifics, injury description, and witness accounts. It includes fields for recording when supervisors and safety personnel were notified, medical treatment details, and comprehensive incident descriptions. This template helps organizations maintain accurate records of workplace incidents, ensure proper reporting procedures, and track safety compliance. Designed for HR professionals and safety managers, this form supports thorough documentation of workplace incidents while maintaining clear communication channels between employees, supervisors, and safety personnel.
by Harry Miles, from the Community
Downloads: 70+
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Template
SMI INCIDENT WITNESS STATEMENT
This incident witness statement form template provides a structured format for documenting workplace incidents and accidents. The form includes essential sections for recording incident details, witness information, safety compliance checks, and detailed observations. It captures crucial information such as the date and time of the incident, location details, witness credentials, and specific observations about safety practices and personal protective equipment usage. The template also includes sections for describing the task being performed, how the incident occurred, and any resulting injuries. Complete with signature fields for both witness and supervisor verification, this form ensures thorough documentation of workplace incidents for safety compliance and record-keeping purposes.
by Mariah Oliveira, from the Community
Downloads: 50+
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Template
TECSIDE Accident / Incident / Hazard Report and Investigation Form
A comprehensive workplace incident reporting document designed to capture detailed information about workplace accidents, injuries, and hazards. The form includes sections for personal information, incident details, injury classification, witness statements, and root cause analysis. It covers various types of incidents from minor injuries to lost time injuries, property damage, and environmental incidents. The document also includes sections for corrective actions, contributing factors analysis, and recommendations for future prevention. This structured approach ensures thorough documentation of workplace incidents and helps organizations maintain safety standards while implementing preventive measures. The form requires signatures from both the host employer and TECSIDE representative, ensuring proper oversight and accountability in incident reporting and resolution.
by Anthony O'Donnell, from the Community
Downloads: 60+
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Template
INCIDENT/NEAR MISS INVESTIGATION REPORT and FIRST REPORT OF INJURY
This document represents a detailed workplace incident investigation form designed to thoroughly document and analyze workplace accidents, injuries, and near-misses. The form includes essential sections for incident identification, employee information, injury details, investigation analysis, equipment involvement, training verification, and corrective actions. It also covers management review processes, insurance reporting requirements, and follow-up procedures. The form ensures proper documentation of workplace incidents while facilitating systematic investigation and implementation of preventive measures. Key components include incident location details, witness statements, PPE verification, and management sign-offs, making it a crucial tool for maintaining workplace safety standards and regulatory compliance.
by Jason Richey, from the Community
Downloads: 50+
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Warehouse Accident: Employee Report

With SafetyCulture you can

Digitize team workflows

Reduce manual errors

Create and share inspection reports

About author

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