Incident Report Sample: A Walkthrough

Learn how to write an effective incident report with our incident report sample

Published 22 Jul 2021

Relevance of Incident Reports

An incident report is a documentation of an event, condition, or situation which may have caused disruption, injury, or damage to a person or company asset. Information recorded in an incident report is used for investigation and analysis to provide the best course of action for preventing recurrence of these incidents.

In the Survey of Occupational Injuries and Illnesses (SOII) conducted by the Bureau of Labor Statistics, it was determined that there were an estimated 2.8 million reports of nonfatal workplace injuries and illnesses in 2019. Gathering this data was made possible through the reports of approximately 200,000 private industry employers.

With this knowledge, governing authorities involved in occupational safety and organizational leaders are able to adjust and implement safer work practices in the workplace to prevent fatal work injuries.

Simply put, an incident report provides organizations the opportunity to optimize their operations through the discovery of pain points revealed by various incidents occurring in the workplace.

Outline of an Incident Report

An incident report only becomes useful through the quality of the information gathered. An effective incident report should be able to provide all the essential information related to a workplace accident, injury, or near miss. The following key elements should be found in your incident report:

  1. General information
  2. Damages and injuries
  3. Affected individual(s)
  4. Witnesses
  5. Corrective actions

Incident Report Sample: Step-by-Step Guide

Now that we have an idea of what information should be included in an incident report, the next question is how should you fill it out? The following principles should be kept in mind:

  • Accurate – data collected must be exact, clear, and specific.
  • Factual – data should be objective and supported by facts.
  • Complete – all essential information should be filled out in the incident report.
  • Graphic – attach photos, diagrams, or illustrations as supporting evidence.
  • Valid – all information written in the incident report must be validated to confirm its truthfulness. Victims, witnesses, managers, or the reporter may sign off on the completed incident report.

To give you a clearer picture of how you can create an effective incident report, we’ll walk you through an incident report sample that we prepared.

Scenario: In one of the warehouses of a manufacturing company in Blaxland, at around 10:30 AM, a forklift was reported to have bumped into crates.

Step 1: Provide Fundamental Information

Following the outline of an incident report form, the first thing you would want to collect are the fundamental information. You can do this by answering the following questions:

  • What type of injury was caused, if any? Was it fatal or non-fatal?
  • Was there any property damage?
  • When and where did it take place?
  • What task was being done at the time when the incident occurred?
  • What was the environment like?

Using the scenario above, the first section of your report would begin to look something like this:



In our incident report example, we took advantage of adding photo evidence to better illustrate the environment where the incident took place. Notice that the photo attached had an annotation. Annotating gives the reader(s) of your report a clearer idea of what to look at. It is helpful in cases where the area of incident is wide and contains a lot of elements.

Step 2: Take Note of Any Damages and Injuries

The next thing you would want to do is to determine the results of the said incident. Did it cause any damage or injure anyone? If so, you should describe it in detail and if appropriate, provide photo evidence of the damage.

Continuing with the scenario, it was determined that the incident caused injury to one of the employees. According to the company’s physician, the injury obtained might only be muscle bruising. However, under the physician’s orders, the injured employee underwent other medical tests to determine other possible injuries. Using this information, you can then include it in the report like this:



Step 3: Identify Affected Individual(s)

Provide the names of the people involved along with their job details such as title, shift arrangement, and other relevant information. Using the same example, the individual who obtained the injury, Samuel, is taken note of along with his job details in the incident report.



Step 4: Identify Witnesses and Take Their Statements

Record the names of people present during the incident and gather their statements. These will be valuable in understanding the sequence of events that led to the incident, and may even provide you better insight of whether or not the behavior of the affected employees was a factor that contributed to the injury or damage. Witnesses’ statements can be noted verbatim or paraphrased. Remember to have the witnesses sign off on their statements to verify the accuracy of what has been recorded.

Continuing with the given scenario, it was determined that another employee was with Samuel when the incident occurred. His name and statement are included in the report and he is asked to sign off to attest that everything he said wasn’t hearsay.



Step 5: Take Action

This refers to the actions that should be taken after the incident. It includes corrective actions that will eliminate recurrence of the incident. The corrective actions section of your incident report can also include the actions that you need to take in order to complete the report.

For example, in the scenario, in Bradley’s statement (the witness), it was discovered that the incident may have occurred due to Samuel’s (the injured employee) failure to perform a pre-start inspection of the forklift before operation. To verify this, you may assign members of your organization to check security footage and maintenance records of the forklift used. With that, the report would look something like this:



Step 6: Close Your Report

Upon completion of the previous sections, you may collect management’s comments on the incident. For accountability measures, you, as the reporter, and someone from upper management should sign off. This will validate that the information stated in the incident report is truthful and unquestionable.

Following the same sample scenario, the incident report will then look like this:



Getting Started with an Incident Report Template

The manual process of collecting incident details and creating a report has proven to become ineffective and tedious over time. As technology continues to evolve, daily tasks are made more efficient and pen-and-paper workflows have all but become obsolete. Incident reports are no exception. Replace manual reporting with a digital solution for easy and paperless documentation of incidents.

Instead of starting from scratch, get started with our ready-built incident report template.

Preview and Download Incident Report Template

SafetyCulture Content Specialist

Jai Andales

Jai Andales is a content writer and researcher for SafetyCulture since 2018. As a content specialist, she creates well-researched articles about health and safety topics. She is also passionate about empowering businesses to utilize technology in building a culture of safety and quality.

Jai Andales is a content writer and researcher for SafetyCulture since 2018. As a content specialist, she creates well-researched articles about health and safety topics. She is also passionate about empowering businesses to utilize technology in building a culture of safety and quality.