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Incident report form template

Record accidents, near misses and other incidents while the details are fresh: when and where, what happened, whether anyone was hurt, witnesses and what's been done since. Staff can fill it in on a phone on the spot.

Use this template, freeNo card needed · edit every question
Questions
11
Takes about
3 min to fill
Style
All on one page

What's inside

  1. 01Your nameShort text · required
  2. 02Your emailEmail · required
  3. 03What date did it happen?Date · required
  4. 04Roughly what time?Short text · optional
  5. 05Where did it happen?Short text · required
  6. 06What type of incident was it?Choice · required
  7. 07Describe what happenedLong text · required
  8. 08Was anyone hurt?Yes / No · required
  9. 09Was first aid or medical treatment given?Yes / No · optional
  10. 10Names of any witnessesShort text · optional
  11. 11What has been done since?Long text · optional

Who uses it

  • Warehouses, workshops, kitchens and construction sites
  • Schools, clubs and venues logging accidents and near misses
  • Shops and offices recording security and conduct issues

Getting better answers

  • Print the QR code and put it next to the first-aid kit, so nobody has to hunt for the link.
  • Turn on email alerts so the right person hears straight away, not at the end of the month.
  • Review near misses as seriously as injuries — they're the warning before the accident.
Want different questions? Browse 44 ready-written question lists
How it looks
Question 1 of 11

Your name

Jane Smith
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Every question and the theme are yours to change once you open the template.

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