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Incident report – construction site

Use this template for the incident report for incidents involving personal injury and material damage on construction sites.

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Close Call (near miss)
Risk to personal injury only - For all asset damage, environmental or reputational events please refer to following sections.
Close Call - no person has been injured but there was a real likelihood that someone may have been injured if no action was taken.
describe event
Action and recommendations
comments
Photos
Injury
Date and Time of incident
Name of injured person
DOB of the injured person
Contact details of injured person
Address of injured person
Name and contact details of witness
Activity when injury was sustained
Where did the injury occur?
Injury Location
Type of injury
Did a first aid responder provide first aid
If no please provide reason
Name and contact details of first aid responder
Details of treatment
Did the emergency services attend?
Which emergency services attended?
please provide names and contact detail is availible
Did the injured person stop work?
State date and time
Name of treating doctor or physician
comments
Photos of incident
Asset Damage
Date and Time of incident
Type of asset that has been damaged eg: vehicle, plant, scaffold, structure etc.....
How did damage occur
Details of responsible party
Has rectification of damage been actioned
Person/organisation completing rectification work
did the incident involve any of the following
Was the emergency services regulator notified/called to the scene?
Name/s and contact details of the person attended
If any person from an emergency service or regulatory office attends the site/scene please contact your line manager and HSE immediately.
comments
Photos
Environmental Impact
Date and Time of Event
Environmental Area that has been effected
clean up requirment
Has clean up been actioned?
by who?
Did the emergency services attend the scene?
person/organisation responsible for the incident
comments
Photos
Impact to Reputation
Date and Time of Event
please provide details
Did the media attend?
what is the likelihood of media interest?
have you had any calls from the media?
comments
Photos
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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