Lumiform
Features Solutions Resources Templates Enterprise Pricing
Select a language
Englishen
Deutschde
Françaisfr
Españoles
Português (BR)pt-BR
en
Log in
Book a demo
Book a demo
Back
Englishen
Deutschde
Françaisfr
Españoles
Português (BR)pt-BR
Features Solutions Resources Templates Enterprise Pricing
Free demo
Log in
en
Book a personal demoView video demoContact sales
Explore
Resource hubCentral repository for all Lumiform resourcesCustomer storiesReal-world successes and experiences with Lumiform.
Learn
Template collectionsComprehensive collections of best practice templates.Topic guidesComprehensive safety, quality, and excellence insights.LexiconDefinitions key to quality, safety, and compliance.
Support
Developer's guideTechnical documentation for developers.Help centerAssistance with onboarding and platform mastery.
Featured reads
Explore our collection of 38 free preventive maintenance checklists

Template collection

Explore our collection of 38 free preventive maintenance checklists

Start reading
Your guide to performing and documenting efficient child care observation

Topic guide

Your guide to performing and documenting efficient child care observation

Start reading
Lumiform as customer journey mapping tool in gastronomy

Success story

Lumiform as customer journey mapping tool in gastronomy

Start reading
Book a personal demoView video demoContact sales
By industry
HospitalityManufacturingConstructionRetailLogisticsFacility managementView all industries
By business needs
Health and safetyQualityOperational excellenceRisk management and complianceView all business needs
By use case
Safety management softwareEnergy audit appForklift inspection appBuilding management softwareVehicle inspection appQMS appKaizen method appProperty inspection appRestaurant inspection appElevator management appProject management softwareFire inspection app
View all app uses
Book a personal demoView video demoContact sales
Overview
Template libraryDiscover over 12,000 free, ready-made and expert proofed templates.
Use cases
CleaningMaintenanceRisk assessmentSupply chainIncident management
Business needs
Health and safety managementQuality managementOperational excellenceRisk management and compliance
Industries
Food and hospitalityManufacturingRetailTransport and logisticsConstructionFacility management
Book a personal demoView video demoContact sales
Overview
Product overviewAll features
Capabilities
Digitize
Form builderMobile AppActions
Automate
Workflow automationApprovalsIntegrations
Transparency and accountability
ReportsAnalytics
Orchestrate
Administration
Book a personal demoView video demoContact sales
Templates
Workplace incident investigation checklist

Workplace incident investigation checklist

This workplace incident investigation checklist is for uncovering the circumstances and conditions that led to the event in order to prevent future incidents.

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
Workplace incident investigation checklist

This workplace incident investigation checklist is for uncovering the circumstances and conditions that led to the event in order to prevent future incidents.

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

This workplace incident investigation checklist streamlines the process of logging and assessing workplace accidents, injuries, and near-misses. It offers an efficient approach approach to gathering crucial information about incidents, including affected individuals, location details, injury descriptions, and witness accounts. When unexpected incidents occur, like an employee suffering a chemical exposure, this template helps you capture time-sensitive information that might otherwise be lost, enabling more effective root cause analysis.

Nearly half (49%) of workplace harm goes unreported, according to Lloyd’s Register Foundation. With a a standardized investigation template, you establish consistency in your reporting practices and improve workplace safety.

Related categories

  • Health and safety management templates
  • Risk management and compliance templates
  • General templates
  • Incident management templates
  • Safety templates
Preview of the template
Reported details
Reported by
Title/Role
Date of report
Phone
Email
Incident Number
Incident Information
Name of affected individual
Location
Date of incident
Time of incident
Specific area of location
Additional personal involved
Extra Information
Incident description
Injuries, if any
Treatments required, if any
Other workers involved
Comments and Signature
Comments
Audit Signature

More templates like this

5 why incident investigation template
5 why incident investigation template
Incident investigation template using 5 Why analysis
Incident management templates
Health and safety incident investigation report
Health and safety incident investigation report
Conduct thorough investigations with this health and safety incident report template. It focuses on analyzing incidents and implementing safety improvements.
Incident management templates
Incident investigation form
Incident investigation form
Document and analyze workplace incidents effectively with this incident investigation form. It helps identify causes and implement corrective actions.
Incident management templates
Incident investigation report template
Incident investigation report template
Use this template for an accident report to investigate accidents in detail.
Incident management templates
OSHA incident investigation form
OSHA incident investigation form
Ensure compliance with OSHA standards using this detailed incident investigation form. It supports you in improving safety practices and regulatory compliance.
Incident management templates
Incident root cause analysis template
Incident root cause analysis template
This template focuses on incidents, helping you document and analyze events to prevent future occurrences.
Incident management templates

Related resources

Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

Topic guides

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

Incident management: A deep diveWorkplace hazards: Effective management techniquesHow to write an incident report: Your complete guide
See all topic guides

Template collections

See comprehensive collections of best practice templates related to this topic.

Top 7 free incident investigation form templates for compliance4 free workplace incident report templatesCollection of 21 free incident report templates for every industry
See all template collections

Use cases

Check out how the Lumiform software can be utilized for related use cases.

Incident management softwareIncident report softwareApply Lumiform's workflow automation platform to all use casesSafety Incident Reporting Software
See all use cases

Other resources

Explore all the additional resources we offer to assist you in mastering this topic.

5 types of incident reportsHow to perform safety inspectionsHow to write a workplace safety policy4 ways process improvement increases profits

Frequently asked questions

How can I use this checklist to develop effective corrective actions?

Use the investigation findings to develop specific, measurable corrective actions that address both immediate and root causes. For each identified hazard or system failure, create actions that eliminate or control the risk. The checklist’s structured format helps you link each corrective action directly to investigation findings. Prioritize actions based on severity and likelihood of recurrence, and assign clear responsibility with reasonable deadlines for implementation.

What if witnesses provide conflicting accounts of the incident?

Document all perspectives without showing bias toward any particular account. Note specific points of agreement and disagreement between witnesses. Consider factors that might affect perception such as viewing angle, lighting, or distance from the incident. Sometimes conflicting accounts reveal important details that a single perspective might miss. The investigation team should analyze these differences to develop the most accurate understanding of what occurred.

How do I use this checklist to investigate near-miss incidents that didn’t result in injury?

Apply the same thorough approach you would for an actual injury. Near-misses are valuable learning opportunities without the associated harm. Document what happened, what could have happened, and what prevented the worst outcome. The checklist helps you identify the barriers that worked and those that failed. Investigating near-misses often reveals hazards before they cause injuries, making them essential for proactive safety management.

What if I discover safety violations during my incident investigation?

Document the violations objectively as factors contributing to the incident without using accusatory language. Focus on the system that allowed the violation to occur rather than individual blame. Consider whether procedures were clear, training was adequate, and compliance was regularly monitored. The checklist aids you in separating intentional violations from those caused by confusion, inadequate resources, or production pressure.


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.
Lumiform logo
Platform
HomeProductAll featuresPricingEnterpriseTrust and securityCustomer success offeringsDownload the appDemo videos
Solutions
IndustriesFood and hospitalityManufacturingConstructionRetailTransport and logisticsFacility management
Business needsHealth and safetyQualityOperational excellenceRisk management and compliance
Uses cases
Learn
Template collectionsTopic guidesLexiconHelp centerJournalInfographicsVideos
Resources
Lumiform templatesby industryby use caseby business needAll categories
Customer storiesDeveloper APIResource hubIntegrations
Company
AboutJobsLegalBook a demoContact sales
© 2025 LumiformTerms and conditionsPrivacyData processingSitemap
App StoreGoogle play