SafetyCulture Staff

Environmental Incident Report Template

Download this free environmental incident report template to record and address workplace incidents that have a potential or actual impact on the environment. Using this template, ensure thorough documentation by describing the incident, its cause, and recommended corrective actions.

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Title Page

Date reported
Reported by
Job title and department
Location

Environmental Incident Details

Date and time of the incident
Location of the incident
Who was the person who identified the incident?
What actually was the incident?
What type of incident was it?
What is the potential or actual environmental impact of the incident?
What steps have been taken or will be taken to prevent this same incident or others like it from occurring in the future?
Who has been told about the incident?
Were any injuries sustained?
Accomplish an accident or injury report and upload it here.
Where has the authorization for the report come from?

Completion

Reporter's Name and Signature
Acknowledgment

SafetyCulture Staff

Environmental Incident Report Template

Use this Template

Print as PDF

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.