An incident report is a formal document used to record the details of an event that results in injury, property damage, or disruption of regular work activities. It is intended for employees, supervisors, and safety personnel responsible for documenting and managing incidents in the workplace. Completing this report helps maintain an accurate account of what occurred and provides a reliable basis for review, investigation, and follow-up in accordance with company procedures.
This incident report template documents all relevant incident information in compliance with organizational requirements. It includes dedicated sections to describe the incident, identify those affected, and record the immediate response. It also includes space for witness information, relevant evidence, and actions recommended to prevent recurrence of the incident. It is designed to ensure that the incident is documented properly, immediate actions are recorded, and preventive steps are identified to avoid future occurrences.
Incident Report Template
How to Use This Incident Report Template
This template is organized section by section and can be filled easily by following the headings and labels in each part. The breakdown below explains every section to make it easier to complete and use the template correctly.
Reporter Information
Use this section to document who prepared the report and when it was completed. Enter the date and time of the report in the first fields. Add your full name, job title or department, phone number, and email address so the report can be traced back to the person who documented the event.
Include the name of the supervisor you notified and the time they were informed. In the final field, write the site or branch where the incident occurred. This section establishes the source of the report, confirms when it was filed, and identifies who was informed immediately after the event.
Incident Report Template
Enter the date and time of the incident, then specify the exact location, including the building, room, or area. Describe the task being performed when the event occurred. List any equipment or asset involved and include its ID or tag number if one exists. From the checklist, select every incident type that applies, such as injury or illness, near miss or unsafe condition, vehicle or traffic, environmental release, behavioral or conduct issue, medical treatment, restricted duty, lost time, fatality, security or criminal activity, or unknown.
Persons Affected
List each person directly affected on a separate line. Enter the full name, specify the role in the workplace (e.g., machine operator, delivery driver, visitor), and tick one status box: Employee, Contractor, or Visitor. Add phone or email for follow-up. If the person has an ID, enter it; otherwise write N/A. If more than three people were affected, duplicate this block of fields (copy and paste) to add additional entries within the same document. Update the numbering to keep the list in order. Limit this section to individuals who were injured or otherwise directly involved; witnesses will be documented in the Witnesses section.
Description of Incident
Write a factual narrative of what happened and how it unfolded. Describe the sequence from the lead-up to the immediate result in plain, neutral language, avoiding opinions or blame. Focus on what was seen, heard, or done during the event and keep the story in order so reviewers can follow the chain of events. If any part of the sequence is unknown or not observed, note that it is unknown.
Immediate Actions Taken
List what was done right after the incident to control the scene and prevent further harm. Examples include first aid, isolating the area, shutting down equipment, calling EMS, or notifying a supervisor. For each action, state who did it and when. Complete the By Whom and Time fields. If more than one person acted, note each name with the corresponding time in the narrative. Keep this section to immediate steps; planned fixes belong under Corrective / Preventive Actions. If no immediate steps were required, write None.
Injuries and Care
Select Yes or No for the injury question. If Yes, list each injured person’s name with a brief description of the injury. Match the names with the entries in Persons Affected. Keep the narrative factual and avoid opinions. If a detail is unknown, write N/A. Tick the care options that apply. Choose on-site first aid, clinic or hospital care, or both, and write the facility name when outside care was given. For Treatment refused, select Yes if anyone declined care, otherwise select No. If no injuries occurred, select No at the top and enter N/A in the remaining fields.
Witnesses
Select Yes or No to indicate whether anyone witnessed the incident. If Yes, write each witness’s full name and contact information on the lines provided. If more than two people witnessed the event, duplicate the witness fields in this document and continue the list in order. If written or recorded statements were collected, select Yes for Witness statements attached and include the notes or forms with this report. If no statements were collected, select No.
Evidence / Attachments
Tick the relevant boxes. If you select Other documents, write the document type in the space (for example maintenance log or training record). Attach the files and give each a clear label so reviewers can match items to the narrative and related fields. Use simple tags such as Photo 1, Sketch A, CCTV clip 10-32, or Tag 4472, and repeat the same label wherever it is referenced in the report. Include file names or reference numbers when available. If an item will be added later, write pending and add it once collected.
External Notifications
Select Yes or No to indicate whether police were notified. If Yes, write the report number in the box. On the EMS/Fire/Regulator line, note who was contacted and when. Include the agency name, the contact person or unit, and any call or case number. If more than one agency was notified, add each entry on a new line. If a number is not yet issued, write pending and update it when available. If no outside notifications were made, select No for police and write None on the EMS/Fire/Regulator line.
Preliminary Causes / Contributing Factors
Select all checkboxes that apply to the event. Categories include procedure, training or competency, equipment or tools, housekeeping, PPE, supervision or staffing, and environment such as weather or lighting. If another factor applies, tick Other and write the specific factor in the space. Use the Notes box to explain briefly how each selected factor contributed to what happened and, when relevant, reference any evidence already attached. Keep this preliminary and fact based. Plan the fixes in Corrective / Preventive Actions rather than here.
Corrective / Preventive Actions
Enter one action per row. Write a clear, measurable step that addresses the contributing factor(s) you selected earlier, then name the responsible person or role in the next column and set a realistic due date. When useful, reference how completion will be verified to keep the follow-up traceable (maintenance ticket number, training log entry, photo label). If you need more space, duplicate the rows and continue in the same format. Keep each action specific and tied to a cause to reduce repeat events.
Approvals
After all sections are completed, the reporter signs and dates to confirm the entries reflect what they documented, the supervisor reviews for completeness and policy requirements and signs and dates to acknowledge the review, and Safety or HR performs the final check for attachments and follow-up and signs and dates to confirm the file is ready for retention. The date beside each signature shows when that review occurred; if a signature is pending, write pending and replace it with the signature date when received.
Office Use Only
This area is completed by Safety or HR after internal review. Leave it blank when you submit the report. After review, the reviewer enters the Case or Reference ID to link this file to internal records, marks OSHA recordable status as Yes, No, or TBD, and notes whether a workers’ compensation claim was filed along with the filing date. They also name who completed the follow-up, add the closure date once all actions and documents are complete, and use Notes to summarize the final outcome and list any attachments or reference numbers that confirm closure.
FAQs
An incident report is a factual written account of an event that caused injury, property damage, operational disruption, or a near miss. You complete it to create a reliable record for investigation, follow-up, and future reference. A good report focuses on what happened, who was affected, the immediate response taken, preliminary contributing factors, and the actions proposed to reduce repeat events. Write in neutral, specific language and avoid opinions.
Complete the report as soon as practical, ideally on the same day and usually within one business day or by the end of the shift. If some information is not yet available, submit the report with what you know and update it once details are confirmed. Near misses should also be documented so trends can be reviewed, even when no injury has occurred.
Work from the top of the form to the bottom. Start with reporter information so the file can be traced to the person who prepared it. Enter incident details and list any individuals directly affected. In the narrative section, describe what happened and how it unfolded in order, using concise, observable facts. Record immediate actions that controlled the scene and note any care given. Add witnesses, attach evidence, and select preliminary causes that likely contributed. Propose corrective or preventive actions that link back to those causes, then sign and date the form and route it for the next review step. If something is unknown at the time of writing, mark it as unknown and update later rather than guessing.
Follow your organization’s submission method. Turn in the completed form to the designated reviewer or upload it to the required system, then attach photos, statements, and related records using consistent labels so reviewers can match evidence to the report. Keep a copy or confirmation for your records. If external notifications or case numbers are issued later, add the reference numbers to the report. When updates are needed, submit an addendum or revised entry so the file shows what changed and when, rather than overwriting earlier information.
About This Template
This workplace incident report template is available in Word and Google Docs; it is designed with careful consideration of standard reporting practices and legal compliance requirements. It includes all the elements required to document incidents, facilitate the investigative process, and keep appropriate records for review.