Incident report form template
Report an injury, near miss or damage at work while it is fresh: what happened, who was hurt, who saw it and what was done.
22 questions · about 3 min · logic · file upload · e-signature
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What are you reporting?
Tick all that apply.
Date it happened
Time it happened
Where did it happen?
Site, building and the exact spot: “Loading dock 2, by the roller door”.
What was going on just before?
The task, and any tools, equipment, vehicles or chemicals in use.
What happened?
Facts, in the order they happened. Say what you saw, not who was to blame.
What you get back
Every response lands in your results the moment it is sent. Turn on email notifications and each one arrives like this, and the same answers become a row in your spreadsheet.
From PulseFormCreator
Subject New response to Report an incident
- What are you reporting?
- An injury or illness
- Date it happened
- 2026-09-21
- Time it happened
- 14:20
- Where did it happen?
- Warehouse 2, loading dock, beside roller door B
- What was going on just before?
- Unloading a pallet of paint tins with the hand pallet jack.
- What happened?
- The jack’s wheel caught on the dock plate lip and the pallet tipped. A 10-litre tin fell and struck Jordan’s left foot. He was wearing safety boots.
and 12 more answers
| submitted_at | What are you reporting? | Date it happened | Time it happened | Where did it happen? | What was going on just before? |
|---|---|---|---|---|---|
| 2026-09-22T09:41:00.000Z | An injury or illness | 2026-09-21 | 14:20 | Warehouse 2, loading dock, beside roller door B | Unloading a pallet of paint tins with the hand pallet jack. |
The first 6 of 43 columns. Export to CSV or Excel, or send each response to Google Sheets, Notion, Airtable, Slack or a webhook as it arrives, all on the free plan. The answers above are made up.
What this form asks, and why
The last column shows how many of the 17 real incident report forms we read ask the same thing.
| Question | Why it is there | Real forms |
|---|---|---|
| What are you reporting? Required | Near misses sit beside injuries: 7 of 17 forms ask for them. | 8 of 17 forms |
| Date it happened Required | On 17 of 17 forms. The timestamp also shows how soon it was reported. | 17 of 17 forms |
| Time it happened | Shifts, lighting and fatigue all depend on it. | 16 of 17 forms |
| Where did it happen? Required | The exact spot. Fills in from ?site= on a posted QR code. | 15 of 17 forms |
| What was going on just before? | OSHA’s Form 301 asks the same: the task, and the tools in use. | 9 of 17 forms |
| What happened? Required | On every form we read. The hint asks for facts in order, not blame. | 17 of 17 forms |
| What could have happened? Required Only when “What are you reporting?” is A near miss: nobody was hurt, but someone could have been | Penn State’s question: a near miss teaches nothing until someone says what it nearly did. | 7 of 17 forms |
| Name of the person hurt or ill Required Only when “What are you reporting?” is An injury or illness | Often not the reporter, so your browser will not autofill it. | 15 of 17 forms |
| They are Required Only when “What are you reporting?” is An injury or illness | Employees, contractors and visitors are recorded differently. | 6 of 17 forms |
| Type of injury or illness Required Only when “What are you reporting?” is An injury or illness | A tick list sorts cleanly in your export; free text does not. | 13 of 17 forms |
| Part of the body affected Required Only when “What are you reporting?” is An injury or illness | “Left wrist”, not “arm”, as St. Lawrence University asks. | 7 of 17 forms |
| What treatment did they get? Required Only when “What are you reporting?” is An injury or illness | A hospital answer ends on a screen telling the reporter to phone now. | 11 of 17 forms |
| Did they stop work or go home because of it? Only when “What are you reporting?” is An injury or illness | Days off decide much of what is recordable or reportable. | 6 of 17 forms |
| What was damaged, and how badly? Required Only when “What are you reporting?” is Damage to property or equipment | Shown only when damage is ticked. | 6 of 17 forms |
| Who saw it? | Names and numbers in one box, blank if nobody saw. | 15 of 17 forms |
| Photo of the scene, equipment or damage | The wet floor or the missing guard, before anyone tidies up. | 5 of 17 forms |
| What was done straight away? | Only 5 of 17 forms ask: how the area was made safe on the day, apart from the lasting fix below. | 5 of 17 forms |
| What would stop it happening again? | The reporter’s idea, kept apart from what the manager decides. | 11 of 17 forms |
| Your name Required | May not be the person hurt. | 9 of 17 forms |
| Your phone number | For the manager’s follow-up call. | 9 of 17 forms |
| Which supervisor or manager have you told? | Shows a manager knows. | 2 of 17 forms |
| Your signature | Optional, so a near miss still takes a minute. | 8 of 17 forms |
What we left out
- Date of birth and gender. 5 of 17 forms ask date of birth. A first report does not need it.
- A root-cause checklist. Investigation is the manager’s next step. Asking the reporter for causes invites blame.
- A body outline to mark. Impossible with a thumb; “left wrist” in words is clearer.
What 17 real incident report forms ask
In September 2026 we read 17 incident report forms that organisations use today (US 12, UK 5) and recorded every field. This is how often each one appears. It is part of the Form Field Index.
The 17 forms we read
- Penn State University (Physical Plant and Auxiliary Safety Offices) · university, US
- Columbia University Irving Medical Center (Facilities Management) · university (contractor incidents on site), US
- Stewards Individual Placements / Stewards Legacy · nonprofit conservation corps, US
- United Charitable · nonprofit (insurer's incident report form, filled in with its own details), US
- ABC Adult School · adult school, US
- Western Carolina University (Campus Recreation and Wellness) · university, US
- The Evergreen State College (Environmental Health and Safety) · public college, US
- Clarke University (Safety and Security) · university, US
- Pleasant Valley Recreation and Park District · park and recreation district, US
- DeSoto County Schools · school district, US
- Community Action House · nonprofit (food pantry and community services), US
- St. Lawrence University · university, US
- Nottingham Trent University · university, UK
- Girlguiding · charity (youth organisation), UK
- Greenwich and Lewisham u3a · community organisation, UK
- Warwickshire County Council (Health, Safety and Wellbeing Service) · county council, UK
- Stockport Council (Greenspace volunteer tasks) · local council, UK
How the form changes as people answer
Most people see a shorter form. These questions and screens only appear when an answer calls for them.
-
When “What are you reporting?” is A near miss: nobody was hurt, but someone could have been
shows “What could have happened?”
-
When “What are you reporting?” is An injury or illness
shows “Name of the person hurt or ill”, “They are”, “Type of injury or illness”, “Part of the body affected”, “What treatment did they get?”, “Did they stop work or go home because of it?”
-
When “What are you reporting?” is Damage to property or equipment
shows “What was damaged, and how badly?”
-
When “What are you reporting?” is An injury or illness and “What treatment did they get?” is Taken to hospital or Admitted to hospital overnight
shows the “Now phone [safety contact] on [phone number]” ending
-
At the end
shows one of 2 thank-you screens: “Report received. Thank you, …”, “Now phone [safety contact] on [phone number]”
Make it yours
-
A QR code at each site
Link posters by the first aid kit to ?site=Warehouse 2.
-
Your number on the hospital screen
Edit the “Now phone” ending with your safety contact’s name and number.
-
The safety team hears at once
Turn on Connect → Email me, or post each report to a Slack channel.
Good practice and the law
This is general information, not legal advice. Rules differ by country and state, so check anything important where you operate.
- US
Tell OSHA of a work-related death within 8 hours; an in-patient hospitalisation, amputation or lost eye within 24. 29 CFR 1904.39
- US
Recordable cases go on the OSHA 300 log and Form 301 within seven calendar days. 29 CFR 1904.29
- UK
Report more than seven days off normal duties within 15 days; record more than three in your accident book. HSE, RIDDOR
- Australia
Notify your WHS regulator immediately of a death, serious injury or illness, or dangerous incident. Safe Work Australia, incident notification
Questions about this template
Does a near miss need a report?
Some must go to the regulator: RIDDOR’s dangerous occurrences and Australia’s dangerous incidents can hurt nobody. Tick “A near miss” and the injury questions stay hidden.
Can this replace OSHA Form 301?
Not as it stands: an equivalent needs all of 301’s information, such as date hired. Add those questions, or copy each case into your 301.
Should the injured person fill it in, or a supervisor?
Whoever saw it or heard first. The injured person’s name is its own question, so a colleague can report for them.
Is it the same as an accident report form?
Nearly. Pick “Accident report” above the preview: the near-miss question goes and a vehicle section appears.
Which form do you need?
The incident report form is one of the inspection, report & evaluation forms. If it is not quite the job, one of these may be.
- Vehicle inspection form template
For the routine check before a trip, before anything goes wrong.
- Return to work form template
When the injured person is ready to come back.
- Maintenance request form template
For a broken step or a leak reported before it hurts anyone.
Start with the incident report form template
Open it in the editor, add your safety contact and post the link by the first aid kit.
Updated 22 September 2026. Evidence read September 2026 from 17 real forms.