Lumiform Mobile audits & inspections
Get App Get App

Incident Report Form Template

An incident reporting form helps safety officers to prepare and submit incident reports. Use the data collected from incident reports to identify the common causes of work-related incidents and to determine how to reduce risk.

Downloaded 5 times

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 Form Template

Hazard and Incident Details

Incident Category

1. Injured Person (if applicable)

Take a photo of the injured person (where appropriate)
Full Name
Date of Birth
Contact Number/ Email

2. Job Details (if applicable)

Job Title
How long in this occupation?
Start time
Total Hours worked
Shift arrangement
Training/ Qualifications

3. Hazard/ Incident Details

Time of incident
Specific Location of incident
Description of hazard incident
Description of injury, illness or property damage
Take/ upload photo evidence of incident, environment or person(s) involved
Date reported to regulatory authority (only if required)

4. Witness Statements (if applicable)

Full Name
Witness signature (if applicable)

5. Completion

Further comments
Full Name and signature of reporting person
Share this template:
This template is also available in:

Similiar templates