Incident report template checklist
Download and use this free general incident report template to capture photo evidence of the incident and injury, capture signatures of the parties involved. you may wish to modify this template so it is more appropriate for your site or workplace needs.
¿Qué incluye este formulario?
Este formulario contiene 11 secciones:
NOTE: This general template can be used for all incidents, however it is important to check with your
Enter job description
Date and time of incident Date
What was the Incident/ Near Miss?
Incident Details
- Were there any injuries?
- Was there any damage to property or plant?
What caused the incident?
Take photo of surrounding environment including any annotations
What actions will be taken to eliminate future repeats of the incident?
Management comments
Signed off by supervisor when corrective actions have been adopted and monitored
Supervisor sign off
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