The purpose of an incident report form is to report accidents, injuries, illnesses, staff behaviour incidents, damages and other workplace events while they are fresh in your mind. Here is a sample incident report form that you can download and use free of charge.

Free Incident Report Form

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To learn more about incident reports, click on the following sections:

1. What Are Incident Report Forms Used For?
2. Who Can Use an Incident Report Form?
3. When Should an Incident Report Form Be Filled Out?
4. What Types of Events Can Be Considered Incidents
5. What Information Should Be Included on an Incident Report?

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Use an incident report form to track injuries in your workplace

1. What Are Incident Report Forms Used For?

An incident report form can be a very useful tool when doing an investigation and analysis of an event because it includes the root cause and corrective actions to be taken.

Incident report forms are used to:

• Record workplace incidents
• Determine the possible causes of these incidents
• Document any actions taken regarding the incident
• Indicate potential risks and uncontrolled hazards in the workplace

Incident reports can be used during the investigation and analysis of an event

2. Who Can Use an Incident Report Form?

Incident report forms are important sources of information that can be used by various individuals including:

• Workers who want to report an incident that they have witnessed
• A person in authority who needs to create a report of an incident
• A member of an organization who wants to raise awareness about an incident that has taken place in the workplace.

An incident report can be used by both workers and people in authority

3. When Should an Incident Report Form Be Filled Out?

It is best to fill out an incident report form as soon as an incident takes place even if it seems like a minor incident. You should treat minor injuries as important as major ones as they could get work and lead to a more serious injury.

4. What Types of Events Can Be Considered Incidents

It may be difficult to decide what types of event could be considered an incident that needs to be recorded. Here are some general examples to help you:

• Incidents that cause significant health and safety risks to your employees or members or your organization
• Events that cause a disruption or that interfere with your organization
• Incidents that can attract negative attention from the media or highlight your workplace in a negative manner
• Something that affects the systems and operation of your worksite

You should record events that might affect the health and safety of your workers

5. What Information Should Be Included on an Incident Report?

Incident report forms vary regarding the amount and type of information they include. Here is a list of some of the key elements that should be found on a thorough form:

• Dates and Times: Both the incident and the report
• Location: Where the accident took place exactly on your job site
• Person(s) Involved: Full Name and contact information of the person involved including their address and phone number as well as their role i.e. employee, visitor, contractor, other (specify)
• Supervisor: Name and contact information of the supervisor in charge of the area – where they were and when they arrived on the scene
• Conditions and Causes: Conditions that might have led to the accident – i.e. wet flooring, loose floorboards, etc. as well as what caused the incident and if anyone else was involved
• Sequence of Events: How the accident happened – chronological timeline
• Description of Injuries: Complete description of any injuries including location on body, severity – if death: time, date
• Action taken: A list of any actions take i.e. ambulance called, first aid administered, police called, etc.
• Damages: A description of any damages to the premises or surroundings that resulted
• Witness Statements: Include their names and contact information along with their complete statements
• Plan of action: A description of any actions taken already or actions to be taken as a result of the incident

Witness statements should be included on your incident report forms

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