Employee Accident and Incident Report

Document what happened when something goes wrong on the job: the injury, the location, the task under way, and the corrective measures taken. Gives safety teams the detail they need to investigate causes and stop repeat events.

Use this template

Was this an Incident or an Accident?

Date

Employee Name

Nombre

Apellido

Investigated/Report completed by Name

Nombre

Apellido

Date of incident/Accident

Time of incident/Accident

Location

What (injury, nature and body part)

What (was the area conditions)

Where (actual location of incident/Accident)

Which (which task was being performed at the time of the incident/Accident?)

Which (Which type Movement was being used at the time)

Description of Incident/Accident

Download Picture Here

Max 10 MB per file

Employee Explanation/Notes

Witnesses (were there any and if so do you have statements?)

Witness/Witnesses Names

What immediate containment measures have we put in place to prevent re occurrence?

Related templates

Browse all reports templates →