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Incident Report
Report #
Date of Report
Reported By
Job Title
Phone
Email
Incident Details
Date of Incident
Time
Location
Type of Incident
Department
Supervisor
Description of Incident
People Involved & Witnesses
Name
Role
Phone / Email
Injured
Statement / What They Saw
Injury / Damage
Injury & Body Part
Treatment
Damage to Property
Police Report #
Cause & Corrective Action
Reported By
Date
Supervisor
Date
※ Does not replace OSHA injury records (e.g. Form 301) or workers’ compensation claim forms where required.
How to fill out an Incident Report
Free Incident Report template
An incident report is a written record of an unexpected event at work — an injury, near miss, property damage or security issue. It captures what happened, who was involved, the injuries or damage and what will be done to prevent it from happening again.
How to fill it out
Fill in the report number, your name, title and contact details.
Enter the date, time and exact location of the incident and check the type.
Describe what happened in order, sticking to facts rather than opinions or blame.
List the people involved and any witnesses, with contact details and a short statement.
Record injuries, treatment and any property damage.
Explain the cause and corrective actions, then sign and have a supervisor review it.
Tips
Write the report as soon as possible, while details are fresh.
Take photos of the scene and keep them with the report.
Report near misses too — they show hazards before someone gets hurt.
Employers covered by OSHA recordkeeping rules must also record certain injuries on OSHA Forms 300 and 301 (or equivalent); this form does not replace them or workers’ compensation claim forms.
Acme Supply Co. warehouse, 500 Commerce Dr — aisle 4, near the loading dock
Type of Incident
Injury / illness
Department
Warehouse
Supervisor
Jane Smith
Description of Incident
Chris Wilson was carrying a 40 lb box of paper to the loading dock when he slipped on water from a leaking roof drain in aisle 4 and fell on his left wrist. No wet-floor sign was posted. Jane Smith gave first aid and drove him to urgent care.
Injury / Damage
Injury & Body Part
Sprained left wrist (X-ray negative)
Treatment
Clinic / urgent care
Damage to Property
None
Police Report #
N/A
Cause & Corrective Action
Leaking roof drain, floor not marked. Drain fixed Oct 13; wet-floor signs added; staff told to report leaks.
People Involved & Witnesses
Chris Wilson · Employee · (555) 345-6789 · Slipped on wet floor while carrying a box
Laura Garcia · Witness · (555) 456-7890 · Saw him slip near the loading dock
All names, companies and contact details are fictional. Click “Fill sample” above to put this example into the empty fields; click again to remove the parts you did not change.
FAQ
When should an incident report be filed?
As soon as possible after the incident, ideally the same day. Your company policy or insurer may set a deadline.
What is a near miss?
An event that could have caused injury or damage but did not, such as a box falling where someone was standing a moment earlier.
Who fills out the incident report?
Usually the injured employee, a witness or the supervisor on duty. A supervisor should review and sign it.
