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Incident investigation report template

Incident investigation report template

Discover the essential components of an effective incident investigation report template. Learn how to streamline your reporting process, ensure compliance, and improve workplace safety with our customizable template. Download now and enhance your incident management today.

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Incident investigation report template

Discover the essential components of an effective incident investigation report template. Learn how to streamline your reporting process, ensure compliance, and improve workplace safety with our customizable template. Download now and enhance your incident management today.

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

When workplace incidents occur, you need a systematic approach to uncover what happened and why. Our incident investigation report template guides you through documenting crucial details, analyzing root causes, and developing effective corrective actions. Unlike basic incident forms, this template focuses on the investigation process itself, helping you identify systemic issues rather than just surface problems.

For example, when a near-miss occurs in your facility, this template helps you document not just the event itself but trace it back to underlying factors like training gaps or procedural flaws. According to the Occupational Safety and Health Administration, incident investigations that focus on identifying root causes rather than assigning blame improve workplace morale and increase productivity by demonstrating commitment to a safe workplace.

Related categories

  • Health and safety management templates
  • General templates
  • Incident management templates
  • Safety templates
  • Workplace safety templates

Created by

Author Name Nicky Liedtke
Preview of the template
Audit
Location of incident
Job Number:
Date of occurrence:
Date reported:
Contractor?
Type of Incident. Select all that apply.
Near Miss?
Was First aid required?
Was Medical Aid necessary?
Restricted Work?
Occupational Illness?
Lost Time Injury?
A Fire or an Explosion?
Failure of Equipment?
Property Damage?
Material or Business Loss?
Motor Vehicle Accident?
Threats?
Other
Injury
What type of injury?
What body part is injured?
Was a follow-up treatment necessary?
Person Involved
Employee's name
Date of Birth
Address
SIN Number
Health Care Number
Description
Specifically describe how the incident occurred.
Witnesses
Include names and phone numbers of all witnesses to the incident. Attach witness statements.
Analysis
What immediate causes, failures to act, and conditions contributed directly to the accident?
What basic causes are the contributing factors? (Job factors, personal factors)
Prevention
What action or recommendations are to prevent recurrence? When? And action by?
Potential of Frequency
Frequent
Probable
Occasional
Remote
Improbable
Severity of Incident
Catastrophic
Critical
Moderate
Minor
Costs of Incident
Estimated:
Actual:
Conclusion
Further comments
Investigated by:
This template was downloaded 19 times

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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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Read in-depth guides covering key topics related to this article.

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5 types of incident reportsHow to implement operational excellenceHow to write a workplace safety policy4 benefits of safety management and how to communicate them

Frequently asked questions

What information should I collect immediately after an incident occurs?

Begin by documenting the date, time, location, and people involved. Take photos of the scene before anything is moved, gather witness statements while memories are fresh, and secure any relevant equipment or materials. Record environmental conditions and any unusual circumstances that might have contributed to the incident. This creates a solid foundation for your investigation.

How do I identify the root causes in my incident investigation report?

Look beyond the immediate cause by repeatedly asking “why” each contributing factor occurred. Examine equipment factors (design, maintenance), procedural factors (work instructions, safety protocols), and human factors (training, fatigue). Focus on system failures rather than individual blame. The template guides this analysis with structured questions that help reveal underlying organizational weaknesses.

When should I complete an incident investigation report?

Complete your investigation report as soon as possible after the incident while details are fresh, typically within 24-72 hours for initial findings. However, thorough root cause analysis may take longer. Don’t rush to conclusions—it’s better to have a complete investigation that takes time than a quick but superficial one. Update the report as new information becomes available.

Author
Nicky Liedtke
Nicky is a content writer and researcher for Lumiform. With her content writing and copywriting experience, she creates high-quality content across a variety of relevant topics. She aims to promote workplace safety, sustainable operational excellence, and continuous improvement in her articles. She is passionate about communicating how technology can be used to have a positive impact on the environment and helping organizations reduce paper waste and achieve their business goals.
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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