incident report form

A safety incident report form is used for documenting details related to accidents, injuries, near misses, and other safety-related events in the workplace. It helps in hazard reporting and ensures regulatory compliance by providing a structured way to record and investigate incidents, identify root causes, and implement corrective actions to prevent future occurrences. [7] [8]

Key components of a safety incident report form include:

• Employee information (name, job title, department)
• Time and date of the incident
• Location of the incident
• Description of the events leading to the incident
• Types of injuries or illnesses sustained
• Body parts affected
• Witness information
• Personal Protective Equipment (PPE) in use
• Root causes and contributing factors
• Corrective actions to prevent recurrence
• Supervisor comments and signature
• Date of report completion

[1] [3] [2] [2] [4] The form should also facilitate the documentation of any unsafe conditions, acts, or procedures that contributed to the incident. [7]

Following the incident, an investigation should be conducted to determine the causes, and the findings must be documented on the investigation form. [5]

The purpose of the investigation is to find the cause of an incident and prevent future occurrences, not to fix blame. [6]