Template

Incident Report Form Template

300+

Use this incident report form template to document and investigate workplace incidents and injuries. Capture personal and incident details, type of injury, affected body parts, medical treatment, time lost, and a clear description of how the incident happened. Record contributing factors such as environment, equipment condition, housekeeping, surface type, footwear, and manual handling. Include photos, notes, and corrective actions with assignees, priorities, and due dates. Sections for WHS manager comments and recommendations support elimination, substitution, engineering, administration, and PPE controls. Complete with digital signatures and export to PDF, Word, Excel, or web link.

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

Mitti

Mitti (by SafetyCulture) is the operations system for every site, shift and standard. Trusted by 80,000 organizations in 190 countries, Mitti publishes free checklists, SOP templates, audit checklists and toolbox talk topics that turn paper processes into a digital audit trail. Download one, put it to work on your next inspection or shift, and see why teams keep coming back for more.

Template

Incident/Injury Report Form

Use this Incident/Injury Report Form to document workplace events quickly and accurately. Capture personal and incident details, supervisor and WHS manager notifications, injury type and affected body part, treatment and time lost, and a full investigation checklist. Record contributing factors, equipment and PPE used, surface and environment conditions, manual handling actions, and preventive measures. Close the loop with corrective actions using the hierarchy of controls (elimination, substitution, engineering, administration, PPE), assign owners and due dates, and track recommendations to completion. Ideal for WHS compliance across industrial and field environments.

by Christina Edlaine De Jesus, from the Community

10+

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Template

Incident Injury Report Form Template

Use this Incident Injury Report Form to document workplace accidents and near misses. Record personal and incident details, witness information, injury type and body part affected, contributing factors, and site conditions. Includes an investigation checklist, risk controls (elimination, substitution, engineering, administration, PPE), and action tracking to prevent recurrence and improve WHS compliance.

by John Patrick Agustin, from the Community

10+

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Template

Incident and Injury Report Form Template

This Incident and Injury Report Form helps teams record and investigate workplace accidents quickly and consistently. The template guides users to capture essential details such as incident time and location, parties involved, injury specifics, contributing factors, equipment condition, PPE use, and manual handling elements. It includes prompts for WHS Manager and Supervisor notifications, investigator observations, and corrective actions across elimination, substitution, administration, and PPE controls. Ideal for workshops and general operations, it supports thorough WHS investigations, consistent reporting, and faster follow-up. Customizable within SafetyCulture.

by Roger Mercado, from the Community

30+

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Template

SafetyCulture Incident and Injury Report Form

Use this customizable Incident and Injury Report Form to record workplace accidents, injuries, and near misses. Capture personal and incident details, witness information, injury specifics, and time lost. Includes an investigation checklist covering contributing factors, equipment condition, environment, PPE, surface types, and manual handling. WHS managers can add findings and assign corrective actions using the hierarchy of controls, with owners and due dates. Ideal for workshops and industrial sites, and adaptable across industries to improve safety and compliance.

by Darryl Bancale, from the Community

20+

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Template

Incident and Injury Report Form

This Incident and Injury Report Form helps teams document workplace incidents and injuries in detail. The template covers personal and incident details, witness information, supervisor or manager notification, injury and illness specifics, and time lost. An investigation checklist guides root cause analysis across factors like training, environment, equipment condition, housekeeping, surfaces, footwear, workload, slips and trips, vehicles, insects or animals, and manual handling. It records PPE use, service dates, and SWMS adherence. The WHS manager section outlines risk control options and corrective actions, assigns responsibilities and due dates, and captures feedback to the reporting worker.

by Joar Baricante, from the Community

10+

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Template

Incident and Hazard Report Form

Use this incident and hazard report form to document events and hazards in the workplace. Capture reporter details, location, incident or hazard type, and a clear description. Record injury information including injured person, contact, nature and location of injury, and treatment provided. Assess risk using consequence and likelihood to determine overall risk level. Identify contributing factors such as inadequate equipment, procedures, supervision, or training, and define corrective actions with control type, due dates, and assignees. Route the report to the right person and capture signatures to close out the report.

by Pooja Prasad, from the Community

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Incident Report Form Template

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