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Employee Accident/Incident Report Form Template

Streamline Your Reporting Process for Workplace Incidents

Accurate reporting of workplace incidents is crucial for safety and compliance. This Employee Accident/Incident Report Form Template helps you document accidents efficiently, ensuring that you meet legal requirements and enhance workplace safety. Use the template to capture essential details like date and time, type of incident, involved parties, and eyewitness accounts, all while streamlining communication with your team and minimizing risks. Plus, this form is WCAG-aligned, ensuring accessibility for all employees. Explore the live template to simplify your incident reporting process.

Use this Template (FREE) Live Preview
Full name
Job title
Department or team
Phone number
Work email
What is your role in reporting this incident?
Injured employee
Witness
Supervisor/Manager
Safety representative
Prefer not to say
Other
Please Specify:
Type of event
Injury/Illness
Near miss/close call
Property damage
Environmental release
Security incident
Unknown
Other
Please Specify:
Date of incident
Time of incident (e.g., 14:30)
Location category
On company premises
Off-site client location
Remote/field
Travel in company vehicle
Travel in personal vehicle on duty
Unknown
Other
Please Specify:
Exact location or address
Task being performed at the time
Was the task routine for you?
Yes
No
Unsure
Brief description of what happened
Were weather or site conditions relevant?
Yes
No
Not applicable
Unsure
Were any injuries sustained?
Yes
No
Unsure
Body part(s) affected
Nature of injury
Please Specify:
Severity assessment
First aid only
Medical treatment (no lost time)
Lost time injury
Fatality
No injury
Unsure
Did the injured person stop work?
Yes
No
Not applicable
Unsure
If treatment was provided, by whom/where?
Date returned to work (if applicable)
Was medical treatment provided?
Yes
No
Not applicable
Unsure
Witness names and contact details
Were there any witnesses?
Yes
No
Unsure
Contributing factors (select all that apply)
Please Specify:
Equipment, tools, or materials involved
Was PPE required for this task?
Yes
No
Not applicable
Unsure
PPE worn at the time
Please Specify:
Immediate corrective actions taken
Recommendations to prevent recurrence
Was the area or equipment made safe?
Yes
No
Not applicable
Unsure
Was the incident reported to a supervisor or manager?
Yes
No
Unsure
Name of supervisor/manager notified
Date of notification
Was external reporting required (e.g., regulator, client, emergency services)?
Yes
No
Not applicable
Unsure
If external reporting occurred, provide details or reference numbers
Where are the files stored or how can they be accessed?
Do you have photos or documents related to this incident?
Yes
No
Reporter full name (serves as signature)
Date of submission
I confirm the information provided is accurate to the best of my knowledge.
Yes
No
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paper art illustration depicting an employee accident incident report form template with pen and office supplies

When to use this form

Use this template right after any on-the-job injury or safety incident, from a slip in the break room to a cut on a job site, a strain while lifting, or a vehicle bump at the loading dock. You get a consistent record that helps supervisors, safety leads, and HR start root-cause reviews, workers comp steps, and return-to-work plans. If no one was hurt, record the event with the Accident report form. To coordinate corrective actions and deadlines across teams, add the case to the Incident report tracking form. This keeps facts clear, timelines tight, and decisions defensible if auditors or insurers ask questions.

Must Ask Employee Accident/Incident Report Questions

  1. What was the date, exact time, and location of the incident?

    Precise timestamps and locations help you reconstruct what happened and identify patterns by shift or site. They also support compliance timelines and show you acted promptly.

  2. Who was involved and what are their roles and contact details?

    Clear identities let you follow up for statements and training needs. If the person is not an employee (contractor, volunteer, or visitor), document it with the Staff incident report form as well.

  3. What task was being performed, and what happened step by step?

    A simple narrative tied to the job task reveals context, unsafe acts, or process gaps. This detail makes root-cause analysis and corrective actions more accurate.

  4. What injuries occurred, which body parts were affected, and was PPE used?

    Specific injury details guide medical care, OSHA recordability, and workers comp reporting. Noting PPE confirms whether controls worked or need improvement.

  5. What immediate actions were taken, who was notified, and was any property lost or damaged?

    Documenting first aid, equipment shutdowns, and notifications shows due diligence and prevents repeat harm. If personal items were misplaced during the event, log them through the Lost and found form.

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