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Incident report form template

Record accidents, near misses and incidents while details are fresh.

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How to make a incident report form

  1. 1

    Check the questions: rename, add or delete any field, or change how it’s answered.

  2. 2

    Add your organisation’s name, a contact line and your logo if you like.

  3. 3

    Choose fillable PDF, printable PDF, Word or HTML, and the paper size.

  4. 4

    Download the incident report form and share it, print it or add it to your website.

About this incident report form

An incident report records an accident, injury, near miss, security problem or other unexpected event. Writing it soon after the event, with facts rather than opinions, protects everyone involved and helps stop it happening again.

The template asks for the date, time and exact location, the type of incident, a factual description, the people involved, any injuries and treatment, witnesses, immediate actions and ideas to prevent a repeat, with signatures from the person reporting and a supervisor.

What’s on the incident report form

The template has 5 sections and 17 questions. Every one can be renamed, moved or deleted.

  • Report details: Reported by; Role or position; Phone; Date of report
  • The incident: Date of incident; Time; Exact location; Type of incident (tick all that apply: Injury, Near miss, Property damage, Security, Illness, Other); Describe what happened, step by step
  • People involved: People involved table (Name, Role, Injury (if any), Treatment given); Was medical treatment needed? (choose one: No, First aid, Doctor or clinic, Hospital); Witnesses table (Name, Phone)
  • Actions: Immediate actions taken; What could prevent this happening again?
  • Signatures: Person reporting with date; Supervisor name; Supervisor signature with date

Tips

  • Describe what you saw and heard, not what you think caused it; leave conclusions to the investigation.
  • Fill it in the same day while details are fresh.
  • Serious injuries may have to be reported to an authority within a set time; check your local rules.

Four ways to save it

A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.

Frequently asked questions

What is a near miss?

An event that could have caused injury or damage but didn’t, such as a falling box that missed someone. Reporting near misses is one of the best ways to prevent real accidents.

Who should fill in an incident report?

Usually the person involved or the first person on the scene, with a supervisor completing the follow-up section. Witnesses can add their own statements on separate forms.

Can I get the incident report form as a Word document?

Yes. Choose “Word” under “Save as” to download a .docx file you can keep editing in Microsoft Word, Google Docs or LibreOffice.

Can I put the incident report form on my website?

Yes. Choose “HTML” to copy ready-made form code with labels and a simple style. Set the form’s action to the address that should receive submissions, such as your own form handler.

Can I change the questions on the incident report form?

Yes. Rename any question, change its answer type (short answer, tick boxes, rating, table and more), move it, or delete it. You can also add whole new sections.

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