Incident Report

Incident Report

  • Shopping Centre

  • Incident date and time

  • Report completed by -

  • Cleaning / Security Company name -

  • Location of the incident

  • Did you see the accident?

Incident Report Investigation

Details of person

  • Name

  • Gender

  • Phone number

Incident Investigation

  • Cause of incident? (Alleged by person)

  • Description of what happened?

  • Description of injury?

  • Treatment?

Slip Trip and Fall Incident Information Required

  • Type of surface?

  • Condition of surface?

  • What was the spill?

  • Take five photos of the spill and the area

  • Footwear?

  • Condition of footwear?

Other factors

  • Carrying anything at the time?

  • Wearing glasses?

  • Walking aids being used?

  • Under the influence of drugs or alcohol?

Witness to the incident?

  • Name and phone number of Witness (1)

  • Name and phone number of Witness (2)


  • Wet weather at the time of incident?

  • Add media

  • Wet floor signs in place?

  • Add media

  • Wet weather matts in place?

  • Add media

Other information?

  • Other details to be included?

  • Add media


  • Select date

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.