Edward Abrahamsen

Hazard & Incident Report Form

Form to collect reports of incidents, hazards and observations

Use this Template

Print as PDF

Use this Template

Go digital today!

Convert your paper checklists into digital forms

Scan this QR code to use this paper checklist on your smartphone or tablet or visit https://safetyculture.com/

Information

Incident Report ID
Report Type
Incident Type
Report prepared by
Date and Time of the Incident
Location of incident/hazard

Incident/Hazard Detail

Description of incident/hazard
Occurred to
Name of witnesses: (if any)
Take/ upload photo evidence

Risk Assessment

Severity (If an injury occurs what would be the likely Consequence)
Likelihood (How likely is it that a person will be injured by the risk)

Edward Abrahamsen

Hazard & Incident Report Form

Form to collect reports of incidents, hazards and observations

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.