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Workplace incident report

Document accidents, near misses and safety hazards clearly, with photos and witnesses, while details are fresh.

Use this template

Free forever · Unlimited responses · Edit everything

Conditional logic
branching by answer
What's inside · 10 questions
  1. 1If anyone is in danger right now, call emergency services first.
  2. 2What are you reporting?
  3. 3When did it happen?
  4. 4Where exactly?
  5. 5Describe what happened, step by step
  6. 6Who was hurt, and what kind of injury?
  7. 7Did anyone need medical treatment beyond first aid?
  8. 8Were there any witnesses?
  9. 9Add photos of the scene, if it's safe to take them
  10. 10What could prevent this from happening again?
  11. 11Who's filing this report?
Live preview

If anyone is in danger right now, call emergency services first.

Once everyone is safe, use this form to report what happened. It takes about 5 minutes.

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