Workplace incident report - One question at a time

Record an accident, injury or near miss with who, where, what happened and what was done, with a signed declaration. One question at a time with photos beside some questions and a trail of what you have answered.

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

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 anybody hurt?
8. Name of the injured person
9. Was first aid or medical care given?
10. In your own words, what happened?
11. What did you do straight after?
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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