Posts tagged "incident report form sample"

Injury Incident Report Form

Report injuries to employees, contractors or others using this basic Injury Incident Report form containing sections where to write down related information, acquire witnesses signatures, note measures applied, etc.

Injury Incident Report Form
Download .doc  Download .pdf

Incident Report Form Fields:

  • Status (Employee, Contractor or other)
  • Outcome (Injury or near miss)
  • Details of injured person (Contact details, work experience, etc)
  • Details of incident
  • Details of witnesses
  • Details of injury
  • Treatment administered
  • Did the injured person stop work
  • Incident inverstigation
  • Risk assessment
  • Actions to prevent recurrence
  • Actions completed
  • Review comments

Employee Incident Report Form

File employee rule violations as well as other inappropriate behavior using this basic Employee Incident Report form containing sections where to write down related information, acquire witnesses signatures, note measures applied, from verbal warning to dismissal. A useful report when it comes to an incident at work.

Employee Incident Report Form
Download .doc  Download .pdf

Incident Report Form Fields:

  • date
    • employee
      • name, title/position
    • manager
      • name, title/position
    • incident
      • date
      • time
      • location
    • description of incident
    • employee explanation
    • witnesses
    • action to be taken
      • verbal warning
      • probation
      • suspension
      • written warning
      • dismissal
      • other
      • explain
    • By signing this document, you acknowledge that you have read and understood the information contained herein
    • Signatures