Workplace incident report - Clean page
Record an accident, injury or near miss with who, where, what happened and what was done, with a signed declaration. A quiet light page: underlined fields, plain choices and a comfort panel for text size and contrast.
About 6 min to complete. safety, incident, compliance, minimal.
Use this templateQuestions in this template
- Your name
- Your job title
- Date of incident
- Approximate time
- Where did it happen?
- What type of incident was it?
- Was anyone injured?
- Name of the injured person
- Was first aid or medical care given?
- What happened?
- What was done straight away?
- Photos of the scene (optional)
- I, ___, declare that the details above are true and complete to the best of my knowledge on ___.
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Workplace incident report.
Report any accident, injury, near miss or hazard. If someone needs urgent help, call emergency services first.