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    All templatesIncident Management · 3 pages · Updated 25 September 2026

    Incident Report Template

    Three-page incident report: a summary with an OSHA-recordable flag, people involved, a five-level severity class, chronology, immediate actions, contributing factors, a 5-Why and corrective actions with owners. It captures much of OSHA Form 301 but is not an equivalent form on its own; the missing items are listed below.

    What's Inside

    1. Incident summary — date and time, location, type (injury, near miss, property, environmental), reported by, OSHA recordable yes or no
    2. People involved — injured person and two witnesses, with department or company and contact
    3. Severity classification — first aid, medical treatment, restricted work, lost time, fatality
    4. Description — what happened, in chronological order
    5. Immediate actions taken
    6. Contributing factors — equipment, procedure, training, supervision, environment
    7. Initial root cause — five "why" lines
    8. Corrective actions — action, owner, target date, status
    9. Sign-off — supervisor, EHS 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

    An internal incident report is your own document; the regulator's forms and clocks are what it has to feed. The US and UK rules below set what must be decided from it, and how fast.

    • 29 CFR 1904.7(a) and (b)(5)

      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.

    • 29 CFR 1904.29(b)(2)–(b)(4) and 1904.33(a)

      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.

    • 29 CFR 1904.39(a)

      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.

    • RIDDOR 2013, reg. 4

      In Great Britain, 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 worker is incapacitated for routine work for more than seven consecutive days, not counting the day of the accident.

    • ISO 45001:2018, clause 10.2

      In a certified system, the root-cause and corrective-action blocks are the evidence for clause 10.2 (incident, nonconformity and corrective action).

    Each source checked on 25 September 2026. Not legal advice; check the text in force for your site.

    Field by field

    If you use this report for recordable US cases, add the Form 301 items it does not ask for: the case number from the 300 Log, the employee's address, date of birth, date hired and sex, the treating health care professional and where treatment was given, whether the employee was treated in an emergency room or hospitalized overnight as an in-patient, the time the employee began work, the injury or illness and the part of the body affected, the object or substance that directly harmed the employee, the date of death if applicable, and who completed the form (name, title, phone, date).

    OSHA recordable? (yes / no)
    Why: Decides whether a Form 301 and a 300 Log entry are due within seven calendar days.
    Common mistake: Answering on the day and never revisiting. A case becomes recordable when the clinic sutures the wound or days away begin later.
    Type: injury, near miss, property, environmental
    Why: Near misses are the events you can learn from before anyone is hurt; the type decides which trend they count in.
    Common mistake: Filing a near miss as property damage because something broke, so it never reaches the near-miss count.
    Severity classification
    Why: First aid is outside the recording criteria; medical treatment, restricted work, lost time and fatality meet them.
    Common mistake: Ticking medical treatment for anything a nurse or doctor did. Under 1904.7(b)(5)(iv) the treatment decides, not the person.
    Description (chronological)
    Why: Form 301 asks what the employee was doing just before the incident and what happened; a timeline answers both.
    Common mistake: Conclusions ("worker was careless") instead of sequence. Form 301 also asks you not to put names or other personal identifiers in these answers.
    People involved: witnesses
    Why: Statements degrade within days; contact details let the investigator follow up.
    Common mistake: Names only, with no department, company or phone number for a contractor's witness.
    Immediate actions taken
    Why: Shows the scene was made safe and who was told, and when.
    Common mistake: Leaving out the time the regulator was notified, which is what an 8-hour or 24-hour report is checked against.
    Contributing factors
    Why: Five prompts push the analysis past the injured person to equipment, procedure, training, supervision and environment.
    Common mistake: Ticking "training" by default, which produces a retraining action and changes nothing else.
    Initial root cause (5-Why)
    Why: A first pass that the investigation can confirm or overturn.
    Common mistake: Stopping at "did not follow procedure". Keep asking until the answer is something the organisation can change.
    Corrective actions: owner, target date, status
    Why: The status column is where closure is tracked.
    Common mistake: Actions that restate the cause ("retrain operator") with no check that the change worked.

    Worked example

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

    BlockEntry
    Incident summary14 March, 10:40 · Goods-in dock 2 · Injury · Reported by shift lead · OSHA recordable: No at 10:50, changed to Yes at 12:15 after the clinic visit
    SeverityMedical treatment: sutures to the left palm (sutures are medical treatment, not first aid, under 1904.7(b)(5)(ii)(D))
    Description10:32 operator began cutting shrink-wrap on pallet 7 with a fixed-blade knife. 10:40 the blade slipped on a strap and cut the left palm. 10:45 first aider applied pressure and a dressing. 11:40 clinic closed the wound with four sutures.
    Immediate actionsKnife taken out of use; the dock bay left undisturbed for photos; supervisor and EHS informed at 10:50
    Contributing factorsEquipment: fixed-blade knife in use although safety cutters are specified. Procedure: unwrapping is not a step in the dock SOP. Supervision: no pre-use check of cutting tools.
    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)

    The seven-day clock for the 301 and the 300 Log starts when the information that the case is recordable came in, here 14 March, not when the form was corrected.

    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)).

    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.

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