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Critical Incident Report Form Template

Effortlessly Document and Analyze Critical Incidents

In the chaos following a critical event, capturing every detail can be challenging. This Critical Incident Report Form Template is designed for organizations that need a systematic way to log unexpected incidents effectively. By using this template, you can ensure thorough documentation, improve accountability, and facilitate post-incident analysis, providing clarity that protects your team and organization in the future. Track incidents accurately, streamline processes, and enhance communication with stakeholders-and try out the live template to see its benefits.

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Your full name
Phone number
Email address
Your role or relationship to the incident
Involved person
Witness
Supervisor or manager
Safety or HSE staff
HR or administrator
Contractor or visitor
Prefer not to say
Other
Please Specify:
Incident date
Incident time (HH:MM and time zone if known)
Location type
On-site - production/operations
On-site - office
Off-site - client location
Remote/virtual
In transit
Parking/loading area
Other/unknown
Specific location (building, area, or address)
Incident type
Please Specify:
Initial severity assessment
No harm
First aid only
Medical treatment required
Restricted duty or lost time
Fatality
Not sure
Was work stopped because of this incident?
Yes
No
Describe what happened (include sequence of events and conditions)
Contributing factors (select all that apply)
Please Specify:
Number of people injured or taken ill
0 None
1
2
3
4
5 or more
Unknown
Highest treatment level required
None
First aid onsite
Clinic or physician
Emergency department or hospitalization
Unknown
Witness names and contact information
Was a supervisor or manager notified?
Yes
No
Property or equipment damage severity
None
Minor
Moderate
Major
Unknown
Describe any damage or environmental impact
Did any environmental impact occur (e.g., spill, release)?
Yes
No
Immediate actions taken (select all that apply)
Please Specify:
Suggested corrective or preventive actions
Responsible person or team for follow-up
Likelihood of recurrence without additional action
Very unlikely
Unlikely
Neutral
Likely
Very likely
Do you have photos or documents you can share later by email?
Yes
No
Electronic signature (type your full name)
Signature date
May we share this report with relevant internal teams to investigate?
Yes
No
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Paper art illustration depicting a critical incident report form template for FormCreatorAI article

When to use this form

Use this form whenever a serious event affects safety, operations, or compliance. Examples include an employee injury on the shop floor, a security threat, property damage, a medical emergency, or a data loss. For workplace injuries, file this alongside an Employee injury report form. To alert staff about a hazard or near miss, add an Incident/injury safety alert form. For theft, assault, or vandalism, capture facts here and, if needed, submit a Police report form or a Crime report form. Managers, safety officers, HR, and IT benefit through clearer timelines and actions. You get faster response, documented accountability, and a complete record for audits, insurance, and prevention.

Must Ask Critical Incident Report Questions

  1. What happened, where did it occur, and at what time?

    These details fix the event in place and time, which prevents confusion later. They help investigators map sequences and cross-check CCTV, access logs, or shift rosters.

  2. Who was involved and were there any injuries?

    Identifying people and injury status drives triage, duty of care, and notifications. If an employee was hurt, pair this report with an Employee accident report form to capture treatment and work restrictions.

  3. What hazards, causes, or conditions contributed to the event?

    This reveals root causes, not just symptoms. It guides corrective actions, training, and risk controls that prevent repeat incidents.

  4. What immediate actions were taken and by whom?

    Knowing the first response shows what worked and what gaps remain. It also avoids duplicate work and enables a smooth handoff to the next team.

  5. Who was notified (supervisor, security, or external agencies), and when?

    Documenting notifications proves compliance with policy and law. It ensures follow-up tasks happen on time and that stakeholders stay informed.

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