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This general template can be used for all incidents. You can modify this template to suit your workplace.

Incident Details

Enter job number

Enter job description

Date and time of incident

What was the incident/ near miss?

Were there any injuries?

Was there any damage to property or plant?

What caused the incident?

Take photos of surrounding environment including any annotations

What actions will be taken to eliminate future repeats of the incident?

Supervisor comments

Sign Off

Signed off by supervisor when corrective actions have been adopted and monitored

Supervisor sign off

General Incident Report Template Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 201

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Audit

This general template can be used for all incidents. You can modify this template to suit your workplace.

Incident Details

Enter job number

Enter job description

Date and time of incident

What was the incident/ near miss?

Were there any injuries?

Was there any damage to property or plant?

What caused the incident?

Take photos of surrounding environment including any annotations

What actions will be taken to eliminate future repeats of the incident?

Supervisor comments

Sign Off

Signed off by supervisor when corrective actions have been adopted and monitored

Supervisor sign off