Incident Report Template

What is an Incident Report Template?

An incident report template is a standardized tool for documenting workplace events such as injuries, accidents, and near misses. An incident report template must be completed at the time of the incident to provide an accurate account of events. Information recorded with this template is used to investigate the root cause of the incident—establishing the appropriate control measures to prevent its recurrence.

What to Include in an Incident Report Template

Following the outline of an incident report template, the first thing you would want to collect are fundamental information. What are the items to write in an incident report template?

• Name of the person preparing the report

• Names and position of the people involved

• Location

• Incident details such as date and time, description of the incident, injuries (if any), status and condition of the environment, and cause of the incident

• Photos related to incident

• Actions taken to ensure the incident does not recur

• Comments and recommendations

• Sign-off

Use this form to report accidents, injuries, medical situations, and near misses, among others.

How to Follow a Standard Incident Report Format

A well-structured incident report format generally includes the following key elements:

• Introduction – The first part of the incident report covers the who, what, when, and where of the incident.

• Body – Talk about the incident from start to finish, ensuring details are laid out in chronological order to avoid confusion.

• Conclusion – Was the incident resolved? How? If the incident was not resolved, explain why, and provide the steps that need to be taken in order to resolve it.

• Sign off – Include the full name and signature of the incident report writer for accountability and record-keeping.

You can leverage an Artificial Intelligence (AI) tool to help you with the format. Instruct the system to create a customized template based on your internal policies.

How to Write an Incident Report Using a Template (with Examples)

Knowing how to write an incident report helps the reporter gather all the necessary details to make the incident report accurate and factual. Here are three steps on how to write a good incident report using a template with their examples:

1. Know what information to collect.

A checklist can be a helpful guide to avoid missing out on important details especially at times when you need to submit the incident report as soon as it is needed.

2. Gather the most accurate and factual data.

Providing the most accurate and factual information is the topmost responsibility of the reporter. Opinions, biased statements, and vague information should be avoided.

3. Provide as much evidence as possible.

Add photos and illustrations to strengthen the validity of the incident report and support the statements given by witnesses.

4. Assign tasks to the appropriate personnel.

Use an AI assistant to create targeted corrective actions—complete with assignee, priority, and status. You may search for existing actions to avoid task overlaps.

Incident Report Examples

The following are a few real-life incident reporting examples in different aspects of workplaces:

General Incident Report Example

“On Monday morning, September 4, 2020, at 7 a.m. in Cehenna Express. located in 5th Avenue, Pandemonium, one of the warehouse staff (Harvey Kinkle) slipped while transferring a piece of 95-lbs equipment to a nearby stock room. Upon further analysis, the root cause of the incident is believed to be the wet flooring due to a leaking water tank in the same location. Adding the fact that Harvey has poor vision, he carried the load himself without seeing the water on the floor.

When Harvey fell, his colleague, Nick, who is about to enter the warehouse, heard a nearby bang that urges him to check what happened. Nick quickly ran to help Harvey. After reporting the incident to the shift supervisor, Mary Wardwell, they decided to call the Pandemonium hospital for an ambulance. Harvey said his head fell badly to the ground when he lost his balance, causing severe headaches, although there was no blood from his injuries.

Harvey was admitted to the Pandemonium General Hospital and a skull fracture was confirmed. Harvey will be out of work for 2 months.

The supervisor is currently working with the safety personnel (Edward Spellman) to evaluate the condition of the floor, the location and condition of the water tanks on the floor, and the lighting systems installed. Also, an eye medical test will be administered to all Cehenna Express staff.”

Fall Incident Report Example  – Construction

“Whilst working as part of the roofing crew on a large residential project, the apprentice was required to climb the 8-meter-high scaffolding to retrieve some tools from the roof at the end of his shift. He put the tools in a bucket and started to climb down with the bucket in his hand. He thought it would be faster to climb the outside of the scaffolding rig. As he climbed onto the outside of the scaffolding, he lost his footing and fell 8 meters to the ground.

The roofing crew team leader called an ambulance as the first aider attempted to revive him. The apprentice was in a coma for three months and after a lengthy period in therapy was eventually able to walk with aids. He was unable to work in the construction industry as a result of his injuries.

The H&S manager investigated the accident using witness statements from the roofing crew and a review of site documentation. The root cause was determined to be lack of adequate supervision and poor communication of safety site rules.”

In the event involving an injury, you can use an accident report form as your injury report form to capture all important information and immediately report the accident. Here’s a sample incident report in a PDF format.

Incident Report Sample PDF | Mitti (by SafetyCulture)