Workplace Incident Report template

A workplace incident report form built for the standard a safety program needs: when and exactly where it happened, incident type including near misses, an injury branch that expands only when someone was hurt, witness names, and a signed accuracy confirmation. The welcome screen says it plainly — near misses count too.

Use this template Start free — no card

11 questions · works on the free plan (500 responses/month) · fully customizable

1 built-in logic rule
E-signature question

What’s inside

The questions this template ships with — rename, reorder, or delete any of them in the builder.

01Your full nameShort text

02When did it happen?Date

03Where exactly did it happen?Short text

04What type of incident?Dropdown

05Was anyone injured?Multiple choice

06Describe the injuries and any treatment givenLong text

07Describe what happenedLong text

08Names of any witnessesShort text

09Sign to confirm this report is accurateE-signature

When to use this template

A warehouse or manufacturing floor where OSHA-style recordkeeping demands every incident documented the same way
A safety officer trying to raise near-miss reporting, which predicts injuries better than injury counts do
A restaurant kitchen after a burn or slip, capturing details and witnesses while memories are fresh
An office documenting a security incident — propped door, unfamiliar visitor — alongside physical hazards

Tips to get more from it

The injury branch is the template's core logic: answer No to 'was anyone injured?' and the treatment-details question disappears. Near-miss reports stay fast, which is how you get more of them.
The what-happened prompt asks for events in order plus equipment involved — investigation-grade detail. The separate exact-location field matters just as much for spotting hazard clusters.
The signature field makes each report a signed statement, which is what an insurer or regulator wants to see. Publishing with a signature requires Pro ($14.99/mo).
The ending screen promises safety-officer follow-up within 24 hours on every report. That promise is what keeps people reporting near misses — put a real name behind it.

Questions people ask

Should near misses really be reported on an incident form?

Yes — the template lists 'Near miss' as its own incident type, and the injury branch keeps those reports short. Near-miss data is the leading indicator; injuries are the lagging one.

How soon after an incident should the report be filed?

Same shift, ideally. The form takes a few minutes on a phone, and details like witness names and event order degrade fastest in the first day.

Can reports be exported for compliance records?

Every response exports as CSV with date, location, type, description, and witnesses in columns, and the signed confirmation stays attached to each response.

Why does the injury question control other questions?

A logic rule shows the injuries-and-treatment question only when the answer is Yes. It keeps hazard observations and property-damage reports from wading through irrelevant medical questions.