Incident Report Form (Free Printable PDF)
Write down what happened while it is fresh: when, where, who, what was done, and who was told.
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An incident report is worth having because memory fades fast. This form asks for the facts in the order you would collect them. The first section covers when and where: the date and time of the incident, the date it is being reported, the exact place — site, room or area — and the task that was in progress. Then a three-row table for the people involved, with their role as staff, visitor or contractor, contact details and the part each played.
The middle of the page is a large open box for the description, headed with a reminder to write the facts in the order they happened. Under it, the injury or damage section has tick boxes for whether anyone was injured and whether first aid was given, lines for the nature of any injury and who treated it, and a line for property, equipment or a vehicle that was damaged. A two-row witness table records names, contact details and what each person saw.
The last section is what was done: an action taken box for the immediate response, lines for who the incident was reported to with their role and the date and time, and a signature, printed name and date for whoever completed the form. Every box and cell is a fillable form field, so a report can be typed up on screen and filed, or printed blank and kept in the first aid station. US Letter or A4.
