Operations & IT

Incident Report Form Template

An incident report form is a form that records what happened in a workplace incident, when and where it occurred, who was involved or injured, who witnessed it and what was done in response so a safety team can investigate and prevent it from happening again. This template covers injuries, near misses and property damage in one form, with steps that guide the reporter from the basic facts to causes and corrective actions.

Use this template — freeTry it first
20 questions
4 pages
~7 min
To fill in
Steps layout
Mobile-ready
Free
No credit card
Incident Report form beside a photo of a warehouse worker filling in a checklist on a clipboard

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Photo by Daniel Andraski on Pexels

Who it's for

Health and safety officers, site supervisors, HR teams, warehouse and construction managers, and facility operators in schools, hospitals and retail.

  • Reporting a slip, trip or fall on the shop floor
  • Logging near misses so hazards are fixed before someone is hurt
  • Recording vehicle, forklift or equipment damage
  • Building the records your safety committee and insurer ask for

What this template asks

Every question can be changed, removed or reordered once it's yours.

Reporter

  1. Your name*

    Short text

  2. Job title*

    Short text

  3. Email*

    Email

  4. Phone

    Phone number

    Optional

  5. Department or site*

    Short text

What happened

  1. Type of incident*

    Multiple choice

    • Injury
    • Near miss
    • Property or equipment damage
    • Vehicle incident
    • Environmental spill
    • Other

  2. Date of incident*

    Date

  3. Time of incident*

    Short text

  4. Exact location*

    Short text

  5. Describe what happened*

    Long text

  6. Names and roles of people involved*

    Long text

  7. Photos of the scene or damage

    File upload

    Optional. Up to 5 files

Injury and response

  1. Was anyone injured?*

    Multiple choice

    • No
    • Yes - minor, first aid only
    • Yes - needed medical treatment
    • Yes - hospital visit or admission

  2. Body part affected

    Checkboxes

    Only if someone was injured

    • Head or face
    • Eyes
    • Neck or back
    • Arm or hand
    • Leg or foot
    • Torso
    • Other

  3. First aid or treatment given

    Long text

    Optional

  4. Witnesses and their contact details

    Long text

    Optional

  5. Immediate actions taken*

    Long text

Causes and prevention

  1. Likely contributing factors

    Checkboxes

    Choose any that apply

    • Wet or uneven floor
    • Equipment fault
    • No or wrong PPE
    • Lack of training
    • Rushing or fatigue
    • Poor lighting
    • Procedure not followed
    • Other

  2. What could prevent this happening again?

    Long text

    Optional

  3. Declaration*

    Checkboxes

    • The information I have given is true and accurate to the best of my knowledge

Tips for more responses

  1. 1

    Put a QR code on site notice boards and in vehicles so incidents are reported from the scene while details are fresh.

  2. 2

    Use email notifications to alert the safety lead the moment a report with an injury comes in.

  3. 3

    Use PDF templates to produce a filled incident report for each submission to attach to insurance or investigation files.

Questions

What should an incident report form include?

The reporter's details, the date, time and exact location, the type of incident, the people involved, a factual description, any injury and body part affected, first aid or medical treatment given, witnesses, immediate actions taken, likely causes, suggested corrective actions and photos of the scene.

Should near misses be reported?

Yes. A near miss is an event that could have caused injury or damage but did not. Reporting them shows hazards early, and many safety programs treat them as just as important as actual injuries.

Do I have to report workplace injuries to a regulator?

Some serious injuries and dangerous occurrences must be reported to a government body, such as OSHA in the US or HSE in the UK, often within a set number of days. The rules vary by country and industry, so check your local requirements; this form is your internal record, not an official filing.

How soon should an incident be reported?

As soon as it is safe to do so, ideally the same shift. Details like times, positions and witness names fade quickly, and early reports make investigations more accurate.

Is this incident report template free?

Yes. Copy it into a free Dculus Forms account, change anything you like and start collecting responses. No credit card is needed.

Can I change the questions?

Yes. Your copy opens in the form builder, where you can add, remove and reorder questions, change the layout and add your own branding.

Where do the responses go?

Responses arrive in your Dculus Forms workspace. You can export them to Excel or CSV, send them to Google Sheets or a webhook, and get email notifications.

Can I host it myself?

Yes. Dculus Forms is open source (GPLv3), so you can run it on your own servers and keep every response in your own database.

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