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Incident hazard report form

Incident hazard report form

Incident hazard report forms are essential for capturing detailed information about safety incidents and near-misses.

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Incident hazard report form

Incident hazard report forms are essential for capturing detailed information about safety incidents and near-misses.

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

You can bridge the gap between hazard identification and incident documentation with this incident hazard report form. When an incident happens, this form enables employees to document the hazard, assess potential risks, and recommend corrective actions.

According to the Canadian Centre for Occupational Health and Safety, workplaces contain numerous hazard types including chemical, physical, ergonomic, and psychosocial. This form empowers your team to address both actual incidents and potential dangers using a consistent, thorough reporting process that supports your safety compliance efforts.

Related categories

  • Health and safety management templates
  • Operational excellence templates
  • General templates
  • Emergency preparedness templates
  • Safety templates

Created by

Author Name Inioluwa Ademuwagun
Preview of the template
Page 1
Incident Description
Incident Date
Incident Time
Incident Location
Incident Description
Involved Personnel
Name of Injured Person
Job Title
Department
Corrective Actions
Immediate Actions Taken
Root Cause Analysis
Recommended Corrective Actions
Completion Date

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Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

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Workplace hazards: Effective management techniquesIncident management: A deep diveHazard communication program: A guide for workplace safety
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Incident management softwareIncident report softwareWorkplace AppApply Lumiform's workflow automation platform to all use cases
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5 Types of workplace hazards5 steps of a fire risk assessmentHow to write a workplace safety policyDisaster risk management: the philosophy of disaster preparedness

Frequently asked questions

How do I determine the root cause when filling out this form?

To determine root causes, look beyond immediate factors. Ask “why” multiple times about the incident circumstances. Consider environmental factors, equipment conditions, training adequacy, and procedural compliance. Consult witnesses and involved personnel for different perspectives. Focus on systemic issues rather than individual blame to identify truly effective corrective actions.

When should I complete the incident hazard report form?

Complete the form as soon as possible after discovering a hazard or incident—ideally within 24 hours while details remain fresh. Don’t wait for injuries to occur; report potential hazards immediately. Even minor incidents deserve documentation, as they often reveal systemic issues that could lead to more serious events if left unaddressed.

How can I use the data from these forms to improve workplace safety?

Analyze completed forms regularly to identify recurring hazards, problem areas, or equipment failures. With Lumiform, you can track metrics like hazard types, locations, and resolution times. Use this data to prioritize safety investments, adjust training programs, and demonstrate improvement to regulators. The patterns revealed often point to systemic issues requiring attention.

Author
Inioluwa Ademuwagun
Inioluwa is a freelance content writer with a passion for words and everything marketing. She has worked closely with B2B SaaS and e-commerce brands creating product-led content. She loves to read fiction and would describe herself as an introverted nerd who desires to travel around the world. She currently doing that with her words till she can with her eyes
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.
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