Lumiform Mobile audits & inspections
Get App Get App

Incident report - construction site

Use this template for the incident report for incidents involving personal injury and material damage on construction sites.
Rated 5/5 stars on Capterra

Say goodbye to paper checklists!

Lumiform enables you to conduct digital inspections via app easier than ever before
  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 5,000 expert-proofed templates

Digitalize this paper form now

Register for free on and conduct inspections via our mobile app

  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 5/5 stars on Capterra

Incident report - construction site

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


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
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.

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

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?
Share this template: