Templates
Employee workplace incident report template

Employee workplace incident report template

Easily document workplace incidents with this template. Capture every detail, analyze incidents, and enhance safety and compliance.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF
Employee workplace incident report template

Easily document workplace incidents with this template. Capture every detail, analyze incidents, and enhance safety and compliance.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

The employee workplace incident report template allows you to document accidents, injuries, and near-misses with precision and compliance. It captures comprehensive details from employee information to incident classification, so no critical information is missed during stressful situations. You’ll be able to track patterns in workplace incidents and implement targeted safety improvements.

Based on research by Alert Media, 76% of employees believe how their employer communicates needs improvement, especially regarding emergencies that might impact them. Our template helps address this communication gap by facilitating clear, thorough incident documentation.

Related categories

Preview of the template
Page 1
Employee Details
Employee Name
Employee ID
Department
Job Title
Incident Details
Date of Incident
Location of Incident
Witnesses (if any)
Detailed Description of Incident
Injury Details
Was the employee injured?
Type of Injury
Parts of Body Affected
Treatment Provided
Incident Classification
Type of Incident
Incident Severity
Corrective Actions
Immediate Actions Taken
Root Cause Analysis
Recommended Corrective Actions
Reporting Information
Reported By
Job Title
Date Reported
Supervisor Name
Supervisor Signature

Frequently asked questions

How can I ensure employees feel comfortable reporting incidents without fear of blame?

Emphasize that the primary purpose of incident reporting is prevention, not punishment. Implement a no-blame culture where reporting is recognized as contributing to workplace safety. Provide multiple reporting channels, allow anonymous submissions when appropriate, and visibly act on reports to demonstrate their value in improving workplace conditions.

What’s a good way to document witness accounts in the incident report?

Interview witnesses separately and promptly while memories are fresh. Record their observations using their own words rather than paraphrasing. Ask open-ended questions and avoid leading statements. Note any discrepancies between accounts without making judgments. Include contact information for potential follow-up questions during investigation.

How do I determine appropriate corrective actions after completing the incident report?

Analyze the root causes identified in your report and develop actions that address these underlying issues. Prioritize solutions based on their effectiveness in eliminating hazards rather than their ease of implementation. Consider both immediate fixes and long-term preventative measures. Involve employees from affected areas in developing practical, sustainable solutions.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.