Template

Incident / Hazard Report Form

100+

Use this hazard report form to: - Identify the incident / hazard type and the level of treatment needed - Record who was injured, their contact number, and the nature of the injury - Document the task/s performed when the incident / injury occurred - Check which factors contributed to the hazard, incident, and/or injury - Specify the control type when creating corrective actions

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 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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Template

Platinum Accident Report V2

This Platinum Accident Report V2 template helps teams document workplace incidents in detail. Capture the date and time, injured person’s name and department, exact injury location on the body, and type of injury. Record a factual description of the incident as reported by the injured person, list witnesses, and note any first aid treatment provided. Track the injured person’s status after the event, including return to work or transfer to medical care. Attach photos of the injury and incident location, and confirm manager notification. The report emphasizes confidentiality and advises leaving the incident site undisturbed until properly reviewed.

by Tim Charlton, 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

LSUSA Incident Report

Use this LSUSA Incident Report template to document both injury and non-injury incidents in the workplace. Capture incident date and time, who it was reported to, location, and any witnesses. Record injury details and treatment, property or vehicle damage, and environmental conditions. Add photos, describe immediate causes and contributing factors, and outline corrective actions with responsible persons. Assess potential severity and probability of recurrence, then sign off to complete a thorough incident record.

by Lenard Garrett, from the Community

20+

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Template

Internal Incident Report Template

This internal incident report template helps teams record workplace events thoroughly and consistently. Capture when and where the incident occurred, who was involved, what happened, injury details, medical treatment, and required follow up actions. Includes fields for incident type, severity, witnesses, and investigator sign off. Use it to standardize reporting, support investigations, and improve safety performance across transport and logistics operations. Fully customizable to fit your procedures.

by Tracey Perozzo, from the Community

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Template

Employees Report of Injury Form

Use this Employees Report of Injury Form to report work related injuries, illnesses, or near miss events. The template guides employees to record incident date and time, witnesses, exact location, task being performed, sequence of events, contributing causes, and what could have prevented the incident. It also captures affected body parts, medical treatment details, provider information, and signatures from the employee and supervisor for follow up actions. Ideal for standardized incident reporting and hazard identification across workplaces.

by Enablement Team, from the Community

20+

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Incident / Hazard Report Form

About author

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