Please enable JavaScript in your browser to complete this form.

Incident Details

Date & Time of Incident
e.g. breakroom, parking lot, etc.

Resulting Actions

Reporter Information

Name of Person Filing Report

Whether you’re a large corporation or a small business, you know that ensuring a safe and secure work environment is paramount.

That’s why we’ve designed our Work Incident Report Form Template to streamline the reporting process and improve workplace safety.

Utilizing the Work Incident Report Form on Your Website

Customize this form template to align with your organization’s safety protocols, and with just a few clicks, you’ll improve workplace safety, accountability, and overall employee well-being.

In the meantime, you’ll find these key elements on our Work Incident Report Form Template:

  • Incident Details: Start by collecting key incident information — date, time, and location.
  • Description: Encourage detailed descriptions to understand the incident’s nature and severity.
  • Witnesses: Capture the names of witnesses to ensure accurate accounts of the event.
  • Action Taken: Document the immediate actions taken in response to the incident.
  • Follow-Up Action: Let the form user specify any required follow-up actions or investigations.
  • Person Filing Report: Gather the name of the person reporting the incident.
  • Email: Collect the contact information for follow-up and clarification.

By incorporating this form on your website, you’ll empower employees to report incidents promptly, contributing to a safer work environment.

Get the Work Incident Report Form Template to enhance safety reporting and foster a culture of security in your workplace today! Signing up with WPForms gives you access to this template and many others to use on your website.