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    All templatesIncident Management · 3 pages · Updated 20 October 2026

    Incident Report Template

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    Three-page incident report for the first record of an unplanned event: who, where and when, type of event, a severity class and the worst credible outcome, people and witnesses, facts in order, immediate actions, who was told and whether an authority notification may be required, a provisional look at contributing factors and a 5-Why, corrective actions with owners, a hand-off to the investigation and sign-off. It states that it is about no blame, keeps facts apart from analysis and asks for no medical detail beyond the severity class. Event types and classes are examples; whether an event must be reported to an authority differs by country and sector, and the form does not decide it.

    What's Inside

    The form opens with a no-blame statement and a privacy line, then keeps facts (sections 1 to 7) apart from a first, provisional analysis (sections 8 to 10).

    Page 1: what happened, to what, where and when

    1. Report details: report number, reported by, date and time of the report, status (initial, updated, final)
    2. What, where and when: date, time of the event, time discovered, location, work being done, type of event (injury or ill health, near miss, damage, environmental, security: examples) and a small table of invented examples
    3. Severity: a six-class example scale from no injury to fatality, the worst credible outcome if it happened again, and a question whether a rule that applies to you makes it recordable or reportable, with who decided and when

    Page 2: the facts and who was told

    1. People involved: injured or affected persons and three witnesses, with department or company, contact and whether a statement was taken
    2. Facts in order: time, what happened and the source of each point
    3. Immediate actions taken: first aid, area made safe, equipment out of use, scene kept, with who and when
    4. Who was told: names, times and how, and an authority notification box: not required, may be required and being checked, or made, with the reference

    Page 3: provisional analysis, actions and hand-off

    1. Contributing factors: equipment, procedure, training, supervision, environment and other, each marked fact, witness or assumption
    2. Initial root cause: five "why" lines
    3. Corrective actions: interim and permanent, with owner, target date and status
    4. Hand-off to the investigation: needed or not, level, lead, reference, evidence kept and who was told
    5. Sign-off: reporter, supervisor, EHS or safety lead and manager, with name, signature and date

    OSHA recordability quick check (29 CFR 1904.7)

    Recordable: death · days away · restricted work or job transfer · medical treatment beyond first aid · loss of consciousness · a significant injury or illness diagnosed by a physician or other licensed health care professional

    First aid, not recordable on that basis alone: wound coverings such as bandages · hot or cold therapy · a non-prescription medication at non-prescription strength

    What requires or shapes this record

    No single rule fixes what an internal incident report must contain; it is your own record, and the rules that apply to you read from it. Where a law applies, it decides what counts as recordable or reportable, to whom and by when, and those rules differ by country, sector and kind of event. The sources below are examples from the US (OSHA recordkeeping, read through the eCFR because osha.gov blocks automated reading), Great Britain (RIDDOR) and Canada (CCOHS guidance on investigation), plus the ILO guidelines on management systems. They show how different the clocks and the thresholds are. This is not legal advice, and no source here makes this form a substitute for the notification or the record your own rules require.

    • 29 CFR 1904.7(a) and (b)(5), 1904.29(b), 1904.33(a) and 1904.39(a) (US, via the eCFR)

      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, or loss of consciousness, or if it is a significant injury or illness diagnosed by a physician or other licensed health care professional. Paragraph (b)(5)(ii) lists what counts as first aid, and (b)(5)(iii) says that list is complete. Under (b)(5)(iv) the treatment decides, not who gave it: a bandage applied by a doctor is still first aid, and sutures are medical treatment. Each recordable case needs an OSHA Form 301 or an equivalent form, entered with the 300 Log within seven calendar days of receiving information that a recordable case occurred. An equivalent form must carry the same information. Section 1904.33(a) requires the 301s to be kept for five years after the end of the calendar year they cover. A separate and faster clock: report a work-related fatality to OSHA within 8 hours, and an in-patient hospitalization, amputation or loss of an eye within 24 hours. If you do not learn right away that such an event happened or was work-related, section 1904.39(b)(7) and (b)(8) start the clock when you or your agent learn it. Section 1904.29(b)(9) lets an employer use discretion in describing a privacy concern case, giving enough to identify the cause and the general severity but no details of an intimate or private nature. These are US federal rules; this page has not checked whether a given employer is covered.

    • RIDDOR 2013, regs. 4, 5, 6 and 12 and Schedule 1 (UK, legislation.gov.uk), read with HSE's RIDDOR pages

      Regulation 4(1) lists the specified injuries to workers that follow the reporting procedure, among them fractures other than to fingers, thumbs or toes, amputations, and loss of consciousness caused by head injury or asphyxia. Regulation 4(2) requires a report within 15 days when a person at work is incapacitated for routine work for more than seven consecutive days, not counting the day of the accident. Regulation 5 covers a person not at work who is taken from the site of the accident to hospital for treatment, and regulation 6 a death from a work-related accident. Schedule 1 says to notify the enforcing authority by the quickest practicable means without delay and to send a report within 10 days of the incident; reports of diseases are made without delay. Regulation 12 requires a record of reportable incidents, and of injuries that incapacitate a person at work for more than three consecutive days, kept for at least three years. "Work-related accident" means an accident arising out of or in connection with work, and "accident" includes an act of non-consensual physical violence done to a person at work. HSE's page on types of reportable incidents adds that not every accident is reportable: it must be work related and result in a reportable injury. These are UK rules; this page does not describe other countries.

    • CCOHS, Incident Investigation, OSH Answers fact sheet (Canada, last revised 23 June 2025)

      CCOHS defines an incident as an occurrence arising out of or in the course of work that resulted in or could have resulted in injuries, illnesses, damage to health, fatalities or material damage, and describes a near miss as an event that could have caused harm but did not. It says the purpose of an investigation is to find facts that can lead to corrective actions, not to find fault, and that seldom if ever is there only one cause. Its first steps are to report the incident to a designated person, give first aid and prevent further injury or damage, then secure the scene and take photographs before anything is moved. Witnesses should be kept apart and interviewed alone as soon as possible, in their own words. A written report should identify clearly where evidence rests on certain facts, witness accounts or the team's assumptions. The sheet advises against recommendations to discipline anyone, and cautions that pre-set forms or checklists may be limiting. It notes that requirements depend on the jurisdiction and that, after a serious injury or fatality, another authority may have jurisdiction and may take control of the scene, so a procedure to coordinate with it is needed.

    • ILO-OSH 2001, Guidelines on occupational safety and health management systems, sections 3.11.7 and 3.12 (International Labour Organization)

      Section 3.11.7 says reactive monitoring should include the identification, reporting and investigation of work-related injuries, ill health, diseases and incidents, and of other losses such as damage to property. Section 3.12 says an investigation of the origin and underlying causes should identify any failures in the management system and be documented; that it should be carried out by competent persons with the appropriate participation of workers and their representatives; that the results go to the safety and health committee, where there is one, and to the persons who take corrective action, and into management review; that the corrective action should be implemented to avoid repetition; and that reports from external investigative agencies, such as inspectorates, are acted on in the same way, taking confidentiality into account. The guidelines are not a law, and no conformity with them is claimed here.

    Each source checked on 20 October 2026. Not legal advice; check the text in force for your site.

    Field by field

    The fields follow the order of the form. Sections 1 to 7 are for facts: what people saw, did and said, with times and sources. Sections 8 to 10 are a first, provisional analysis and are marked as such, and section 11 passes the report to whoever investigates. The event types, the six severity classes and the investigation levels are examples; change them to your own scales. If a law you work under needs more items on a recordable case, add them, and add no medical detail that your procedure does not need.

    Reported by (name, role)
    Why: The author is the first person the investigator calls, and the role shows how close they were to the event. The report number printed beside it ties this sheet to your register.
    Common mistake: Writing only a department. The author is often not the person who saw the event, which is why section 5 asks for a source on each fact.
    Time of the event (24 h, estimated if unsure)
    Why: Times are the spine of the facts, and a notification clock may run from the time of the event or from the time you first knew. The discovery time sits in its own box next to it.
    Common mistake: Entering the time the form was filled in, so no one can tell how long the event waited before it was reported.
    Location (site, area, exact place)
    Why: An investigator, an authority or an insurer must be able to find the spot. The place also shows who controlled the premises, which can decide who must report.
    Common mistake: "Warehouse" with no bay, line or machine named.
    Type of event
    Why: Tells the reader which trend the report feeds and which other form is also needed. A near miss is an event that could have caused harm but did not; it is not the same as a planned observation conversation. The five types are examples.
    Common mistake: Ticking only injury, so the damage, the spill or the security element is lost. Tick all that apply, and also fill in the spill or release report for a release.
    Class (example scale)
    Why: Records what actually happened to people, on a scale your site chooses. Where a law defines first aid or medical treatment, its definitions decide, not this scale.
    Common mistake: Ticking medical treatment for anything a nurse or doctor did. Under 1904.7(b)(5)(iv) the treatment decides, not the person.
    Potential outcome if it happened again
    Why: Actual harm is partly luck. Rating the worst credible outcome lets a near miss or a minor injury get the attention it deserves and sets how deep the investigation in section 11 goes.
    Common mistake: Copying the actual outcome into this box, so every near miss looks trivial.
    Recordable or reportable under a rule that applies to you?
    Why: A flag for the person who knows your rules, and a record of who decided and when. It is a question, not an answer: "not yet known" is better than a guess.
    Common mistake: Answering on the day and never revisiting. A case becomes recordable when the clinic sutures the wound or days away begin later.
    Injured or affected person
    Why: Names who was affected and how to reach them or their manager. The form asks for no diagnosis: section 3 holds the class of outcome and that is the only health information the report needs.
    Common mistake: Writing the diagnosis, medical history or medication here, which spreads health information to everyone who reads the report.
    Statement taken (date, by)
    Why: Shows who has been asked and by whom. Witnesses should be interviewed alone and soon, in their own words, and contact details let the investigator follow up.
    Common mistake: Names only, with no department, company or phone number for a contractor's witness, or letting witnesses compare notes before they are asked.
    Facts in order
    Why: Separates what was seen, done or said, in time order, from what anyone thinks it means. The Source column shows whether a point was seen, was told or comes from a record.
    Common mistake: Conclusions ("worker was careless") instead of sequence.
    Immediate actions taken
    Why: Shows that the person got help, the scene was made safe and whether it was kept for the investigators, with who did what and when.
    Common mistake: Clearing the scene before photographs or notes are made, so evidence the investigators needed is gone.
    Who was told
    Why: Records who knew what and when: the internal chain, emergency services, representatives and any outside party such as a client or an insurer.
    Common mistake: Leaving out the times. A later check of a deadline needs the time someone first knew.
    Authority notification
    Why: Some events must be reported to an authority within a set time, and the rules differ by country, sector and event. The box asks you to decide with the person who owns the duty and to record the answer, not to assume it.
    Common mistake: Writing "not required" because the event looks small, or assuming it is required without asking, and not noting the time you first knew.
    Contributing factors (provisional analysis, not fact)
    Why: Five prompts (equipment, procedure, training, supervision, environment) push the analysis past the person involved. The Basis column marks each entry as fact, witness or assumption.
    Common mistake: Ticking "training" by default, which produces a retraining action and changes nothing else.
    Initial root cause (5-Why, provisional)
    Why: A first pass that the investigation can confirm or overturn. There is no single definitive method for root cause analysis, and the 5-Why is one popular tool.
    Common mistake: Stopping at "did not follow procedure". Keep asking until the answer is something the organisation can change.
    Corrective actions (interim and permanent)
    Why: Interim actions make the place safe now and permanent ones remove the cause. The status column is where closure is tracked.
    Common mistake: Actions that restate the cause ("retrain operator") with no check that the change worked.
    Hand-off to the investigation
    Why: A report records the event; an investigation finds the causes. The hand-off says whether one is needed, how deep, who leads it and where the evidence is kept.
    Common mistake: Treating the 5-Why in section 9 as the investigation, or letting the investigators rewrite the original report instead of keeping their findings in their own record.

    Worked example

    IllustrativeHand laceration at a goods-in dock (invented site and people)

    SectionEntry
    Event and report14 March, 10:40 · Goods-in dock 2, unwrapping pallet 7 · Type: injury · Reported by the shift lead at 10:50 (report IR-0314-01, status initial)
    Severity and recordabilityClass at 10:50: first aid. Class at 12:15: medical treatment, because the clinic closed the wound with sutures (sutures are medical treatment, not first aid, under 1904.7(b)(5)(ii)(D)). Potential outcome if repeated: medical treatment. OSHA recordable: No at 10:50, changed to Yes at 12:15 after the clinic visit; the EHS lead decided and wrote the time on the report. No other medical detail is recorded.
    Facts in order10:32 operator began cutting shrink-wrap on pallet 7 with a fixed-blade knife (seen by the shift lead). 10:40 the blade slipped on a strap and cut the operator's hand (told by the operator and one witness). 10:45 first aider applied pressure and a dressing. 11:40 clinic closed the wound with sutures (told by the operator).
    Immediate actionsKnife taken out of use; the dock bay left undisturbed for photos
    Who was toldShift lead at 10:40, in person; supervisor and EHS lead at 10:50, by phone. Authority notification: not required, checked at 12:15 against the rule the site works under (in the US, 29 CFR 1904.39 covers a death, an in-patient hospitalization, an amputation or the loss of an eye, and none of these happened). The site's own decision, recorded with the time.
    Contributing factors (provisional)Equipment: fixed-blade knife in use although safety cutters are specified (fact, seen by the shift lead). Procedure: unwrapping is not a step in the dock SOP (assumption). Supervision: no pre-use check of cutting tools (assumption).
    5-WhyBlade slipped on a strap → a fixed blade was in use → safety cutters had run out → the consumables list has no reorder point for them (stop: a system the site can change)
    Corrective actionsAdd safety cutters to the reorder list with a minimum of 20 (Stores, 21 March) · Add unwrapping to the dock SOP (Dock supervisor, 28 March) · Remove fixed blades from dock tool boards (Shift lead, 15 March, done)
    Hand-off to the investigationNeeded: yes, supervisor review by the dock supervisor and the EHS lead, handed over on 14 March. Knife and photos kept by EHS; safety representative told on 15 March.

    The seven-day clock for the 301 and the 300 Log (a US example) starts when the information that the case is recordable came in, here 14 March, not when the form was corrected, so the entries are due by 21 March.

    When a spreadsheet stops being enough

    A spreadsheet of incident reports holds the events; it does not route them. The limit shows when reports come from several sites or shifts: nobody is told when a first-aid case turns recordable, the seven-day, 8-hour and 24-hour clocks run on memory, and corrective actions sit in a column nobody is reminded about.

    A software record adds notification and escalation, a status history for each action and exports that rebuild the 300 Log and 301 without retyping. Check that edits keep their history: stored 300 Logs must be updated with newly discovered recordable cases during the retention period (1904.33(b)(1)).

    Incident reports also hold names, contact details and sometimes health information. A shared folder or sheet shows everyone everything; check whether a system can limit who sees witness contact details, keep the original report unchanged when an investigation starts, and keep the facts apart from the analysis that follows.

    Same rule for every product: tagged “Incident Management” or “Incident Reporting”, with a sourced incident reporting or management capability in its record, or one the vendor stated to us, labelled as vendor-stated. Documented and conditional capabilities qualify; check the linked scope before treating a module as included.

    Tekmon pays for a sponsored placement (above); its place in this list follows the same rule as every entry. How lists are ordered

    All 56 matching profiles are shown. Documentation review, not hands-on testing or a claim of compliance.

    Reuse and credit

    Licensed CC BY 4.0: copy, adapt and share this template, also commercially, if you credit it, link to the licence and say if you changed it, without suggesting that QHSEtech endorses you. What the licence covers.

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