Incident Report Form
Accurate incident reporting is a legal obligation under the Occupational Health and Safety Act. All workplace incidents, accidents, and near misses must be reported and investigated promptly. This form guides you through every required step.
The form covers initial notification, injury classification, witness statements, root cause analysis, corrective actions, and management sign-off — everything needed for internal records and mandatory COID or DoL reporting where applicable.
What’s included
- Incident classification matrix (7 categories)
- Injured/affected party details section
- Witness statement fields
- Root cause analysis framework (5-Why method)
- Corrective & preventive action log
- COID reporting reference checklist
- Management approval & sign-off blocks
How to use this template
- 1Download the PDF / DOCX file and open it in your preferred editor.
- 2Replace the [bracketed] placeholders with your site, company, and project details.
- 3Work through each section against your operation and the legislation referenced below.
- 4Have it reviewed and signed off by your SHE representative or responsible person before use on site.
Legislation & standards
This template is structured to support compliance with:
Always confirm the current legal requirements applicable to your specific operation and jurisdiction.
Who this is for
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