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Workplace Incident Report Form
A workplace incident report form with injury details, witness statement fields, a 5 whys root-cause section, corrective actions, and OSHA/RIDDOR deadlines.
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What you get
- An incident report form covering what happened, where, who was involved, and any injury
- A witness statement section with guidance on capturing the witness's own words
- A 5 whys root-cause worksheet and a corrective actions table with owners and due dates
- OSHA recordkeeping and reporting deadlines, plus a UK RIDDOR summary
- Routing guidance for non-injury incidents such as harassment, security events, and near misses
Template preview
A preview of the structure. Download the PDF or CSV for the complete, ready-to-use version.
Section 1: Incident details
- Report number— e.g. INC-2026-014
- Date and time of incident
- Date and time reported, and to whom
- Exact location— site, building, floor, area, e.g. Warehouse B, loading dock 3
Section 2: People involved
| Name | Role / employer | Involvement | Contact | Injured? |
|---|---|---|---|---|
| D. Reyes | Forklift operator, employee | Operating forklift | ext. 2214 | No |
| S. Patel | Picker, agency worker | Struck by falling carton | via agency | Yes |
Section 3: Injury or illness details
- Injured person's name and job title
- Nature of injury— e.g. laceration, sprain, burn, fracture
- Body part affected— be specific: left forearm, not arm
- First aid given, and by whom
Section 4: Witness statement
Complete one statement per witness. Interview witnesses separately and as soon as possible. Ask open questions ("What did you see?" "What happened next?") rather than leading ones ("Did you see him run?"). Write down the witness's own words, including uncertainty ("I think it was around 2pm"). Don't correct, summarize, or add conclusions. Read the statement back or let the witness read it, then have them sign and date it. The witness can add corrections before signing.
- Witness name, job title, and contact
- Where the witness was and what they were doing
- What the witness saw or heard— in their own words, in order
- What happened immediately afterward
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How to use this template
- 1
Deal with the immediate situation first
Get first aid or emergency care, make the area safe, and preserve the scene (photos, damaged equipment) before anyone starts on paperwork.
- 2
Complete the report the same day
The supervisor or person in charge fills in sections 1 to 4 within 24 hours while details are fresh. Late reports lose detail and can miss OSHA reporting windows.
- 3
Take witness statements separately
Interview each witness on their own, let them describe events in their own words, and have them read, sign, and date their statement.
- 4
Find the root cause, not just the person
Use the 5 whys section to work back from what happened to the system or process failure behind it, then assign corrective actions with owners and dates.
- 5
Decide on recording and reporting
HR or safety checks whether the case is recordable on the OSHA 300 log, whether it must be reported to OSHA, and whether a workers' comp first report of injury is due.
Frequently asked questions
What should an incident report include?
The date, time, and exact location; a factual description of what happened in sequence; the people involved and any witnesses; details of any injury and treatment; immediate actions taken; the root cause; and corrective actions with owners. Stick to observed facts and leave blame out of it.
How soon should a workplace incident report be completed?
Ideally the same day, and within 24 hours at the latest. For OSHA purposes you have 7 calendar days to record a recordable case, but the 8-hour and 24-hour reporting deadlines for fatalities and severe injuries mean the facts need to reach HR or safety immediately.
What makes an injury OSHA recordable?
A work-related injury or illness is recordable if it results in death, days away from work, restricted work or transfer, medical treatment beyond first aid, loss of consciousness, or a significant diagnosed condition. First aid is a defined list in 29 CFR 1904.7, such as bandages, non-prescription medication at non-prescription strength, and cold or hot packs. Stitches and prescription medication count as medical treatment.
How do you write a witness statement?
Interview each witness separately, ask open questions, and write down what they saw and heard in their own words and in order. Include uncertainty rather than tidying it up. Have the witness read, correct, sign, and date the statement.
Should near misses be reported?
Yes. A near miss is the same failure without the injury, so investigating it is the cheapest way to prevent the next real incident. Near misses aren't recordable on the OSHA 300 log, but tracking them shows where hazards are building up.
Who should fill out the incident report?
Usually the supervisor or person in charge of the area completes the main report, with input from the injured person where possible. Witnesses give their own statements. HR or the safety lead then reviews it, decides on recording and reporting, and tracks corrective actions.