Incident report form template
A comprehensive form for documenting workplace incidents, accidents, injuries and near misses. Ensures incidents are reported consistently and meets WHS compliance requirements.
Incident report form
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Why you need an incident report form
Under Australian WHS laws, businesses must record workplace incidents, injuries and near misses. A standardised incident report form ensures all relevant information is captured consistently and meets your compliance obligations.
Proper incident documentation helps identify hazards and prevent future accidents. It also provides critical evidence if an incident results in a workers' compensation claim or investigation by a safety regulator.
This form covers injuries, near misses, property damage and other workplace incidents, making it versatile for all types of safety reporting.
Key features of this form
Designed to meet WHS requirements and support investigations
Structured reporting
Systematic format to capture all critical details of the incident.
Incident classification
Categories for different incident types (injury, near miss, property damage).
Detailed description
Space to document exactly what happened and immediate actions taken.
People involved
Record details of injured parties, witnesses and first responders.
Investigation notes
Section for initial findings and contributing factors.
Timestamp record
Precise time and date logging for incident and response actions.
What's included in this form
Comprehensive sections for complete incident documentation
Incident details
Date, time, location and type of incident (injury, near miss, property damage, etc.).
Reporter information
Name, position and contact details of the person submitting the report.
Injured party details
Information about anyone injured, including nature and location of injuries.
Incident description
Detailed account of what happened, including sequence of events and conditions.
Immediate action taken
First aid provided, emergency services called, hazards made safe, etc.
Witness statements
Names and accounts from anyone who saw the incident occur.
Contributing factors
Environmental conditions, equipment issues or other factors that may have contributed.
Corrective actions
Immediate steps taken to prevent recurrence and recommended improvements.
Supervisor review
Space for manager to add comments and confirm investigation completion.
Signatures
Sign-off from reporter, supervisor and safety officer where applicable.
When to use this form
Essential for workplace safety and compliance
What incidents should be reported
Any workplace injury, no matter how minor, should be documented. This includes cuts, strains, slips, trips and falls. Near misses - incidents that could have caused injury but didn't - should also be reported as they help identify hazards.
Property damage, equipment failures, security incidents and dangerous occurrences should all be recorded using this form. Notifiable incidents under WHS laws require additional reporting to the regulator.
Reporting timeframes
Incidents should be reported as soon as possible after they occur, ideally within 24 hours. This ensures details are fresh and corrective actions can be taken promptly.
Serious incidents that require notification to the WHS regulator must be reported immediately by phone, followed by written notification within required timeframes.
Investigation and follow-up
After an incident is reported, a supervisor or safety officer should review the form, investigate contributing factors and determine corrective actions. The form should be kept on file as part of your WHS records and reviewed periodically to identify trends.
Looking to automate this process? RosterElf's HR software handles incident reporting digitally, eliminating paper forms and manual tracking.
Who should use this form?
Essential for any business with workplace safety obligations
Legal disclaimer
This template is designed to reflect Australian workplace standards and WHS legislation at the time of publication. It is provided as a general guide only and does not constitute legal advice.
You should review and tailor this template to suit your business, industry, specific hazards and workplace circumstances. For notifiable incidents or complex safety matters, seek independent legal or WHS advice.
Regulatory sources
This template is aligned with Australian workplace health and safety requirements.
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Disclaimer
This document is a general HR template provided for informational purposes only. It is not legal advice and may not reflect the latest changes in legislation or apply to every workplace situation. RosterElf Pty Ltd and the template provider accept no liability for any loss arising from reliance on this document. Users should seek independent legal advice and customise the template to ensure it complies with all relevant laws, awards and workplace requirements.