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Accident Report Form Template

Create clear and concise accident reports effortlessly

When accidents happen, a clear record can make all the difference. This Accident Report Form Template helps you document incidents in a detailed, organized manner, ensuring you have the information needed for insurance claims and safety investigations. You'll benefit from quick deployment, an easy-to-follow format, and the ability to keep your workplace compliant, while also promoting safety practices. Plus, it's designed with WCAG-aligned labels for accessibility. Start using this effective tool today to streamline your reporting process.

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Your full name
Role or job title
Department or team
Phone number
Email address
Are you the injured person?
Yes
No
Not applicable
Incident date
Incident time (e.g., 14:30 or 2:30 PM)
Incident location or site
Specific area (e.g., warehouse aisle, room number)
Incident type
Injury
Near miss
Property damage
Environmental spill
Vehicle incident
Security incident
Illness/exposure
Unknown
Other
Please Specify:
Initial severity assessment
No injury
First aid only
Medical treatment
Lost time
Fatality
Unknown
Describe what happened
Was work stopped due to the incident?
Yes
No
Not applicable
Injured person's full name
Relationship to the organization
Employee
Contractor
Visitor
Customer
Student
Member of public
Unknown
Other
Please Specify:
Job title or role of injured person
Injured person's phone
Injured person's email
Employee or ID number (if applicable)
Was medical treatment provided?
Yes
No
Unknown
Where was treatment provided?
On-site first aid
Clinic or urgent care
Hospital ER
Hospital admission
Self-treated
Not applicable
Unknown
Name of treating provider or facility
Did the injured person leave work?
No
Yes, returned same shift
Yes, left early
Yes, did not return
Not applicable
Unknown
Nature of injury (select all that apply)
Please Specify:
Body part(s) affected (select all that apply)
Please Specify:
Side affected
Left
Right
Bilateral
Central
Not applicable
Unknown
Primary mechanism/event
Please Specify:
Personal protective equipment (PPE) in use
Please Specify:
Was PPE worn correctly?
Yes
No
Partially
Not applicable
Unknown
Witness 1 name
Witness 1 phone
Witness 2 name
Witness 2 phone
Were there witnesses?
Yes
No
Unknown
Environmental conditions at the time
Please Specify:
Was equipment involved?
Yes
No
Not applicable
Unknown
Equipment name or ID
Equipment condition
Good
Damaged
Missing guards
Improperly set
Malfunctioning
Not inspected
Unknown
Not applicable
Housekeeping at location
Good
Fair
Poor
Not applicable
Unknown
Controls in place before the incident (select all that apply)
Please Specify:
Initial suspected causes (select all that apply)
Please Specify:
Immediate actions taken (select all that apply)
Please Specify:
Were emergency services contacted?
Yes
No
Not applicable
Unknown
Which services were contacted?
Ambulance
Fire
Police
Poison control
Environmental response
Not applicable
Other
Please Specify:
Time supervisor was notified (e.g., 15:10)
Supervisor name
Reference or case number (if provided)
Was the incident reported to an external authority?
Yes
No
Not applicable
Unknown
Temporary corrective actions implemented (select all that apply)
Please Specify:
Target date to complete investigation
Person responsible for follow-up
Additional notes
Is further investigation required?
Yes
No
Unknown
May we contact you for follow-up questions?
Yes
No
Signature (type your full name)
Date signed
I certify that the information provided is accurate to the best of my knowledge.
Yes
No
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Paper art illustration depicting an accident report form with pen and office supplies for FormCreatorAI article

When to use this form

Use this form right after any injury, vehicle collision, equipment damage, or near miss on your site, in your store, or on the road. Supervisors, safety leads, and HR benefit from clear details that trigger care, repairs, and prevention. For road impacts or vandalism, note facts here and, if needed, complete a Police report form. If the event involves only employees, pair this with a Staff incident report form to track internal follow-up. When conditions are unsafe, document the stop and controls alongside your Stop work authority reporting form. The outcome: a time-stamped record you can use for insurance, root cause reviews, and corrective actions.

Must Ask Accident Report Questions

  1. What happened, step by step?

    A clear timeline reduces guesswork and helps you and investigators reconstruct the scene. Specific actions and conditions (such as speed, PPE, and weather) support accurate root cause analysis.

  2. Where and when did the incident occur?

    Exact time and location let you match CCTV, shift logs, and sensor data. It also determines jurisdiction and required notifications.

  3. Who was involved and what injuries or damage occurred?

    Listing employees, contractors, and bystanders ensures you notify the right people and offer care. Detailing injuries or property damage sets priority and supports insurance and safety decisions.

  4. What immediate actions did you take?

    Recording first aid, isolating hazards, and temporary fixes shows due diligence and prevents secondary harm. For events that threaten operations or reputation, escalate with a Critical incident report form.

  5. What evidence or witnesses can you provide?

    Photos, diagrams, equipment IDs, and witness contacts strengthen the record and speed insurance review. If you suspect theft or assault, submit a Crime report form in addition to this record.

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