Incident report - first response checklist

Template Information

Quickly gather the facts. collect evidence about an incident, accident or injury. conduct full investigations quickly with this incident report template.

Category: construction

Template Questions

  • Date & Time of Incident Date
  • Location of Incident Address
  • First Incident Details
  • Site / Project Name
  • Incident Type?
  • Name of on-duty supervisor at time of incident?
  • Describe what happened. Please be detailed but state only facts.
  • What were the weather / environmental conditions at the time of the incident?
  • Which of the following do you need to attach to this report to accuractly document this incident?
  • Please log all relevant evidence below
  • Evidence Description
  • Evidence ID number (if applicable)
  • Record Evidence and Information
  • Photos of evidence (if applicable)
  • Please detail any further information regarding this evidence (if applicable)
  • Please log all relevant vehicle details below
  • Vehicle Make
  • Vehicle Model
  • Vehicle Registration
  • Driver (if applicable)
  • Photos of equipment (if applicable)
  • Please detail any further information regarding this vehicle (if applicable)
  • Please log all relevant damage details below
  • Damage description
  • ID number (if applicable)
  • Photos of damage (if applicable)
  • Please detail any further information regarding this damage (if applicable)
  • Please log all relevant details of other items below
  • Item description
  • Photos of item (if applicable)
  • Please detail any further information regarding this item (if applicable)
  • Please log all relevant equipment details below
  • Equipment Make
  • Equipment Model
  • Equipment ID number (if applicable)
  • Please detail any further information regarding this equipment (if applicable)
  • Please document all people involved in this incident, including yourself (the person reporting the in
  • Full Name
  • ID number
  • Contact phone number
  • What is this person's relation to the incident? (select all that apply)
  • Please describe this person's involvement with the incident, including all relevant information
  • Person
  • Type of injury or illness? (select all that apply)
  • Parts of body affected? (select all that apply)
  • Describe this injury or illness
  • What was the cause of this injury or illness?
  • Corrective Actions
  • Sign Off
  • Name & Signature of Reporter