Free Incident Report Template 51Free Incident Report Template 51Free Incident Report Template 51
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TEMPLATE

Incident Report
ID No.:

Section 1: Details of person completing the report
Last name:

First name:

Department:

Report date:

/

/

Contact phone no.:

Position:

Section 2: Incident type
Hazard

Near miss

Injury/illness
Property damage
Other
to person
or loss
*All workplace incidents must be immediately reported to your manager / supervisor

_______________________

Section 3: Incident description (what happened)
Description of incident:

Location:

Date:
/

/

Time:
_____ am/pm

Section 4: Incident cause(s)* (how it happened)
*Indicate the most relevant causes of the incident including near misses or hazards
Injury / Illness to Person
Property Damage or Loss (includes financial loss)
Falls, trips and slips of a person

Fire

Motor Vehicle

Misleading statement/s

Hitting objects with a part of
the body
Being hit by moving objects
Sound and pressure
Body stressing
Heat, electricity and other
environmental factors
Chemicals and other substances

Explosion
Flood
Arson
Sto