Templates
Workplace incident report template

Workplace incident report template

Use this template to record incidents that have led to injuries in the workplace. It interrogates many different situations where an incident could have taken place.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF
Workplace incident report template

Use this template to record incidents that have led to injuries in the workplace. It interrogates many different situations where an incident could have taken place.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

We created this workplace incident report template to help you establish a standardized approach to documenting accidents and safety concerns. Unlike generic forms, this template includes specialized sections for environmental factors, equipment involved, and detailed injury assessment—essential elements for thorough investigation and compliance.

When you need to document a chemical spill in your laboratory or a machinery malfunction in your production facility, this template guides you through capturing all necessary information for proper analysis and follow-up. Recent data from the Bureau of Labor Statistics shows that 2.6 million nonfatal workplace injuries occur annually in private industry, emphasizing why proper documentation is not just good practice—it’s essential for workplace safety.

Related categories

Created by

Author Name Inioluwa Ademuwagun
Preview of the template
Inspection
Victim
Name
Job Title
Store/Department
Work Address
Gender
Contact Number/Email
Alleged Offender(s)
Do you know the person(s) responsible?
Specify Name(s)
Approximate age
Gender
Relationship to the victim/reporting employee
Details of the Incident
Type of Incident
Description of Incident
Description of any injury, illness or property damage
Take/ upload photo evidence of incident, environment, person(s) involved
Date reported to regulatory authority
Completion
Observations and comments
Name & signature of person reporting
This template was downloaded 22 times

Frequently asked questions

What information should be included in a workplace incident report?

A comprehensive workplace incident report should include the date, time and location of the incident, names of involved employees, detailed description of what happened, any injuries sustained, witnesses present, immediate actions taken, and recommendations for prevention. Include photos or diagrams when possible to provide visual context.

Who is responsible for filling out the workplace incident report?

The immediate supervisor or manager typically initiates the workplace incident report, but input should come from all involved parties. The injured employee provides their account, witnesses contribute observations, and safety personnel may add technical assessments. Ultimately, management should review for completeness before submission.

What are the legal implications of not properly documenting workplace incidents?

Failing to properly document workplace incidents can result in regulatory fines, increased liability in potential lawsuits, difficulties with workers’ compensation claims, and challenges demonstrating compliance during inspections. Proper documentation serves as your legal protection and demonstrates your commitment to maintaining a safe workplace.

Author
Inioluwa Ademuwagun
Inioluwa is a freelance content writer with a passion for words and everything marketing. She has worked closely with B2B SaaS and e-commerce brands creating product-led content. She loves to read fiction and would describe herself as an introverted nerd who desires to travel around the world. She currently doing that with her words till she can with her eyes
This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.