Template

Franklin Smith Incident Report and Investigation Form

Document workplace incidents with a structured form that captures site, date and time, people involved, injuries or damage, and a clear description of events. Identify key contributing factors across environment, human factors, equipment, and methods. Apply the 5 Whys to determine root cause, review supporting documents, and record corrective actions with owners and due dates. Includes a WorkSafe NZ notifiable event prompt.

With Mitti 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 Mitti 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

SafetyCulture

Mitti (by SafetyCulture) is the operations system for every site, shift and standard. Trusted by over 80,000 organisations, Mitti brings your people, operational data and workflows into one operating picture. From the frontline to the boardroom, it gives everyone a clear understanding of what's happening, highlights what needs attention and recommends what to do next. Every inspection completed, issue raised and action taken becomes intelligence your teams can use to improve every day.

Template

5 Why Incident Investigation Template

Use this 5 Why incident investigation template to examine workplace incidents and identify root causes. Capture key details such as team members, incident type, date and time, people and equipment involved, and injuries or damage. Record evidence including photos and statements, then progress through five iterative why questions to reveal the underlying cause. Classify the root cause across areas like risk assessment, procedures, design, quality control, maintenance, human factors, management, training, communication, or environmental factors. Assess hazards, contributing behaviors, and existing controls, and document practical recommendations and corrective actions to improve safety and prevent recurrence.

by Brianna Sanders, from the Community

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Template

JC Civil Event Report Template

This JC Civil event report template helps construction teams document and investigate site incidents, injuries, near hits, and environmental or property damage. Capture event details, people involved, witness information, vehicle data, and site specifics. Record injury and damage descriptions, analyze contributing factors across materials, equipment, environment, and people, and assess associated risks. Assign preventative and corrective actions, note medical treatment, and log WorkSafe NZ notification and investigation details with dates and signatures.

by Accounts JCCivil, from the Community

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Template

Mitti Incident Investigation Report Template

This Mitti incident investigation template helps teams document serious incidents from first report through close out. Capture incident details, environmental conditions, and a timeline of events. Log evidence, vehicles, equipment, damages, and other items. Record people involved, statements, injuries, and affected body parts. Perform root cause analysis using contributing factors and five whys, then assign and track corrective actions. Finish with investigator sign off and follow up tasks. Designed for workplace health and safety across industries.

by Jeff Q, from the Community

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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

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Template

Incident Report - Full Investigation Checklist

Use this 3CIX incident report template to capture critical details after an incident, from what happened and where, to weather conditions, evidence, and people involved. Log injuries, affected body parts, equipment and vehicle information, and damages. Build a clear event timeline, attach photos, and document statements. Guide your root cause analysis with contributing factors and five whys, then record corrective actions and sign off. Ideal for construction teams seeking thorough investigations and consistent reporting.

by Mehran Khan, from the Community

10+

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Template

Final Incident Report Template

Document incidents comprehensively with a structured final incident report template. Capture date, location, and nature of the event, note injuries or property damage, and record the sequence of events. Identify released energies and contributing factors, list facts, and define corrective actions and controls. Attach supporting documents such as photos, statements, and permits. Include supervisor details and investigator signoff to close out the investigation and improve safety.

by Amy Hunter, from the Community

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Franklin Smith Incident Report and Investigation Form

About author

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5 Why Incident Investigation Template

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