Workplace incident report - Dark steps

Record an accident, injury or near miss with who, where, what happened and what was done, with a signed declaration. A dark, high-contrast version in short steps, with solid answer tiles and numbered questions.

About 6 min to complete. safety, incident, compliance, dark.

Questions in this template

1. Your name
2. Your job title
3. Date of incident
4. Approximate time
5. Where did it happen?
6. What type of incident was it?
7. Was anyone injured?
8. Name of the injured person
9. Was first aid or medical care given?
10. What happened?
11. What was done straight away?
12. Photos of the scene (optional)
13. I, ___, declare that the details above are true and complete to the best of my knowledge on ___.

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