Free Incident Report Form: Workplace Injury and Incident Report, Near Miss Report, and an Incident Investigation and Corrective Action Log (PDF, Word, Excel)

What is on the page

Type of incident

Injury, illness, near miss, property damage, vehicle, fire or spill, security or violence. One report can tick more than one.

Description

What the person was doing and what happened, in order, in plain words. Facts only, not blame: "the ladder rolled", not "he was careless".

Witnesses

Names and contacts, and whether a written statement is attached. Get statements the same day.

Reporting checks

Whether the case is OSHA recordable, entered on the OSHA 300 log, a severe injury that must be reported to OSHA, and whether workers' comp, the insurer or police were told.

Corrective actions

What will be changed so it does not happen again, with an owner, a due date and a tick when done.

Writing a good incident report

Look after the injured person first and make the area safe. Then write the report the same day, ideally the same hour, while memories are fresh. Describe what happened in order and in plain language, record exact times and places, and take photos of the scene and any equipment involved. Talk to witnesses separately and ask for short written statements. Avoid blame and opinion in the report; the aim is to find out why it happened so it doesn't happen again. Record the immediate cause, then look deeper for the root cause which is usually a missing control, training or procedure rather than one person's mistake.

OSHA recording and reporting in the US

Most employers with more than ten employees must record work-related injuries and illnesses on the OSHA 300 log if they involve more than first aid: medical treatment, days away from work, restricted work or job transfer, loss of consciousness, or a significant diagnosed injury. Some low-hazard industries are exempt from routine record-keeping. All employers must report severe events directly to OSHA: a work-related fatality within 8 hours, and an in-patient hospitalization, amputation or loss of an eye within 24 hours. Workers' compensation claims have their own state deadlines, so tell your insurer promptly. Check the current rules for your industry and state; this form doesn't replace the official OSHA forms.

Why near misses matter

For every serious injury there are many near misses with the same causes. A near miss is a free warning, but people only report them if it's quick, nobody gets blamed, and something visibly changes. Keep the near miss form short, let people leave their name off, thank whoever reported it, and tell the team what was fixed. In the sample, a worker nearly hit by a reversing forklift led to a new beeper and a painted walkway within a week which encourages the next report.

Following through on corrective actions

The corrective action log is where investigations either lead to change or quietly stop. Give every action an owner and a due date, review the open actions at a regular safety meeting, and close them only when the fix is in place. Over a year the log also shows patterns, such as several incidents involving the same equipment or agency workers, which point to the next training need. Book training with the training attendance sheet and request repairs with the maintenance request form.

Editing the files

The PDFs are fillable, and the Word versions are editable for your company name, report numbering and incident types. Keep completed reports confidential, with medical details limited to those who need them. This template is a practical form, not legal advice; check the reporting rules for your state and industry.

Questions

What should an incident report include?

Who was involved, date, time and location, the type of incident, a factual description, injuries and treatment, witnesses, the immediate and root cause, reporting checks, corrective actions and signatures.

When must a workplace injury be reported to OSHA?

A work-related fatality within 8 hours; an in-patient hospitalization, amputation or loss of an eye within 24 hours. Other recordable injuries go on the OSHA 300 log.

What is a near miss?

An event that could have caused injury or damage but didn't, such as a falling object that missed someone.

Who should fill in an incident report?

Usually the supervisor, with the injured person and witnesses. Anyone can fill in a near miss report.

How soon should an incident report be written?

The same day, as soon as the person has been cared for and the area is safe.