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Incident report form template

An incident reporting form template 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.
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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
Sex
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
Reported
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
Contact
Statement
Witness signature (if applicable)
5. Completion
Further comments
Full Name and signature of reporting person
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ncident Report Form Template: Document and Address Safety Incidents


An incident report form template is a standardized tool used to document and report safety incidents or accidents that occur within a workplace or organization. It serves as a crucial document for recording essential details, investigating the incident, and implementing corrective actions.


This template typically includes sections to capture information such as the date, time, and location of the incident, a description of what happened, individuals involved or affected, witness statements, and any immediate actions taken. It may also have sections to assess the severity of the incident, identify contributing factors, and recommend preventive measures.


By utilizing an incident report form template, organizations can promptly and accurately document incidents, enabling a comprehensive understanding of the event and its implications. It facilitates the investigation process, helping identify root causes and implement corrective actions to prevent future incidents.


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.