Real Examples of Incident Reports at the Workplace with Templates (2023)

Real Examples of Incident Reports at the Workplace with Templates (1)

Accidents can happen, no matter how many preventative measures are in place. And, when accidents do happen, it’s vital to learn from them. To ensure your documentation is spotless, it’s always a good idea to look at some example incident reports at the workplace.

A safety incident report helps ensure nobody is subject to mistreatment because it contains information from the injured employee as well as eyewitnesses. This helps fill in missing pieces of information and figure out how the accident occurred exactly.

“The safety of the people shall be the highest law.”

Marcus Tullius Cicero

So, let’s dive in!

If you’re looking for an example of an incident report at the workplace, feel free to jump to that section using the links below. Otherwise, we will first discuss what incident reports are and why they are so important.

Contents hide table of content

1 What is a Workplace Incident Report?

2 What should you include in an incident report?

3 How to Write an Incident Report

4Incident Report Examples

(Video) INCIDENT REPORTING & INVESTIGATION

4.1 Injury Incident Report Example

4.3 Fall Incident Report Sample

4.4 Hand Injury Incident Report Sample

4.5 Exposure Incident Report Sample

4.6 First Aid Incident Report Sample

5Incident Report Form Templates

5.1 Incident Report Form for General Staff (Word/PDF)

5.2 Incident Report Form for a Construction Site

(Video) Incident Report Template

5.3 Incident Report for a Hospital/ Medical Clinic (Word/PDF)

6 Conclusion

What is a Workplace Incident Report?

A workplace incident report is a document that states all the information about any accidents, injuries, near misses, property damage or health and safety issues that happen in the workplace.

They are very important to identify the root cause of an incident along with any related hazards and to prevent it happening again in the future. As soon as an incident takes place and everybody in the workplace is safe, a work incident report should be written up.

Typically, a workplace accident report should be completed within 48 hours of the incident taking place. The layout of an accident incident report should be told like a story, in chronological order, with as many facts as the witnesses can possibly remember.

What should you include in an incident report?

There are many different types of incident reports, depending on your industry, but most will include the underlying details listed below in order to understand what happened:

  • The type of incident that took place
  • Where the incident happened
  • The date, day and time of the incident
  • Names of the people involved
  • Injuries that were obtained
  • Medical treatment that may have been required
  • Equipment that was involved
  • Events leading up to the incident that could have contributed to it taking place
  • Eyewitnesses that can tell their side of the story

For example…If a chemical was involved in the incident, it should be noted if the victim was wearing appropriate PPE or not, as well as a photograph of the damage and the chemical’s label stating its components.If a workplace vehicle was involved, all information about the vehicle should be noted, and the possible reasons why it occurred if there is no clear answer. Employers should ensure vehicle safety guidelines are adhered to in order to prevent incidents in the workplace.

If this is an OSHA recordable incident (accident) and the company is exempt from OSHA recordkeeping, the employer must also fill in OSHA Form 300. This form enables both the employer and the agency to keep a log of the injuries or illnesses that happen in the workplace. It includes crucial information such as the number of working days missed due to injury, the sort of injury that was obtained and if medical treatment was necessary.

How to Write an Incident Report

It is important to lay out an incident report clearly and concisely with all the relevant information about what happened. The clearer it is to read, the easier it will be to understand the cause of the workplace accident.

The language used for incident reporting should not be too emotional and should not purposefully put the blame on someone. Here is an incident report example template:

Introduction

This should include the who, what, where and when of the employee incident:Who was involved.What happened.Where exactly in the workplace it happened. E.g. Floor leading to the second stairwell in the main building.When it took place. E.g. The time, day and date.A brief summary of what happened.

Body

This must include all the details on the incident. It should be chronological, so nothing is left out.

Conclusion

This should state whether the incident was resolved and what the outcomes were.

Summary

Here, the employee should conclude the report while mentioning what happened again. The accident report should be signed to acknowledge that it is everything that the employee remembers happening.

This workplace incident report template includes the basic guidelines and best practices of what to include to make sure the report includes all the details it should. Once a report is written, it should be kept on record in the workplace.

Incident Report Examples

Depending on the type of workplace incident, the writer will need to include various pieces of information. If you are not sure how to write an incident statement, here are example incident reports for the workplace covering various scenarios.

Injury Incident Report Example

“At 11.20am on Tuesday 7th July 2020, a worker, Timothy Johnson, tripped over an electrical wire on the Blue & Green construction site, located on Main Street, Riverside. He was carrying a hammer at the time.

It is believed the wire should not have been stretched across the ground without safety tape securing it to the ground and drawing attention to it. Timothy fell to the ground and dropped the hammer but did not injure himself with it. He twisted his ankle, which immediately began to swell and scrapped the side of his leg in a minor way. A co-worker came to assist Timothy to his feet and helped him walk to a nearby bench. Timothy could not put his weight on his left foot, so he was taken to a nearby hospital. Once at the hospital, doctors confirmed that Timothy had sprained his ankle and would have to keep the foot elevated and use crutches for the next two weeks. He would not be able to work during this time.

The foreman for the construction site has assessed the wires on the ground and concluded that brightly colored tape should secure the wires to the ground to draw attention to them and to ensure there are no bumps in the wire that are easy to trip over so that this does not happen again”.

Forklift Accident Report Sample

“On Friday 5th July 2020, at 3.35pm, a forklift driver, Max White, was driving the forklift he usually drives in the Sunny Side Warehouse, ABC Street, when the front right tire got caught on a piece of wood on the ground, causing the forklift to overturn with Max inside it.

Luckily a co-worker was nearby to help Max climb out of the right side of the forklift. Max was shaken up and reported that his left shoulder and left side of his neck were hurting him from the impact. Max decided he did not need to go to the hospital as he felt like he would only obtain bruises from his injuries and that they were not severe enough to need medical attention. His manager sent him home for the rest of the day to ensure he did not strain himself further.

The wood that caused the forklift to overturn had not been stacked properly and has now been moved to a secure location in the warehouse to make sure it does not cause any more issues for forklift drivers”.

(Video) How To Write An Incident Report

Fall Incident Report Sample

“In Fairview Boutique on Friday March 6th, 2020, Samantha Wright was stacking shelves while standing on a ladder in order to reach the top shelf of handbags at 4.10pm.

As she was stretching to place a bag on the shelf, the ladder collapsed from under her and she fell to the ground. Her co-worker heard the loud noise and immediately helped her. Samantha was in a lot of pain and could not get to her feet as she felt lightheaded. An ambulance was phoned, and she was brought to hospital. Samantha obtained a broken right arm, bruised thigh and hip, and a bump to the head that left no major head injury. She was recommended three weeks off work at the minimum by doctors.

The fall was concluded to be of nobody else’s fault but was put down to Samantha accidently overreaching instead of moving the ladder to where she needed to see”.

Hand Injury Incident Report Sample

“On April 21st, 2020, at Willow Maintenance, Yellow Abbey Grove, Kyle Jenkins was about to use a miter saw to cut some timber, but when he started to use the saw, it jolted, causing the saw to come down suddenly on his hand.

Kyle’s left thumb was cut deeply by the saw and he lost a lot of blood. Co-workers came to his aid, turned the saw off and helped him stop the bleeding with tissues. He was then brought to the hospital where he received eight stitches and was told to not use the hand for rigorous work for 4 weeks. The head of Willow Maintenance inspected the saw to check for any issues and see why it came down and cut Kyle’s hand. It appeared that whoever was the last person to use the machine did not put the safety latch back on the saw once they had finished using it.

If this safety latch was on the saw when Kyle used it, it would not have cut his hand, but rather, automatically shut off once it jolted. The manager decided to take a day to retrain his staff to ensure they adhere to the health and safety guidelines of the company”.

Exposure Incident Report Sample

“In Woodbell factory, Springville, on Tuesday May 26th, 2020, Annie Bedley was packaging household cleaning products when a bottle tipped over onto her wrist.

She got up from her seat to wash off the chemical in the washroom. She then went to her supervisor to show her what had happened. Annie’s wrist was red and itchy but was not burning as she had washed off the remnants of the chemical immediately. Annie’s supervisor brought her to the office to sit with a cold compress on her hand and applied a layer of ointment to treat the burn. Annie did not feel like she would need further medical assistance and agreed with her supervisor that she would need two to three days off work to ensure the burn did not get irritated.

Annie was wearing appropriate PPE at the time of the incident and no faults were found on the conveyor belt at the packing bay. The incident has been noted as an accident with nobody to blame. Photographic evidence of the burn has been included in this file”.

(Video) Incident Investigation Reporting

First Aid Incident Report Sample

“On Friday November 15h 2019, Arthur Stokes was walking along the corridor between building four and five of Graygrock Inc. when he noticed that there was something sharp sticking through the bottom of his right shoe.

He stopped to see what it was and found a nail stuck in his shoe. He took his shoe off and lucking was able to pull the nail out as it hadn’t pierced through to his foot and only minorly scraped it. He saw the stairwell was getting new handrails fitted and presumed the nail came from that. He saw two other nails further along the corridor and decided to pick them up to make sure nobody else stood on them. He reported to his manager’s office where he presented the nails and explained the situation. His foot had a small cut, so Arthur’s manager gave him an anti-septic wipe and a band-aid to help him.

Arthur returned to work while his manager talked to the construction workers about keeping their workspace neat and to prevent any further accidents like this from happening”.

Incident Report Form Templates

The layout of an incident report forms can vary depending on where the incident took place and the type of injuries. Here are some examples of incident reports at the workplace that you can use.

Real Examples of Incident Reports at the Workplace with Templates (2)

Incident Report Form for General Staff (Word/PDF)

This general staff accident report form template can be used in a variety of workplaces. It includes all the necessities to describe a workplace incident to ensure it is recorded correctly. This general form is ideal for any business type.

Real Examples of Incident Reports at the Workplace with Templates (3)

Incident Report Form for a Construction Site

This example incident report for the workplace is unique to others as it includes a field for the construction project name and the project manager’s details. This makes it easy to understand where in the construction site the accident occurred and how severe it was.

Real Examples of Incident Reports at the Workplace with Templates (4)

Incident Report for a Hospital/ Medical Clinic (Word/PDF)

The hospital incident report template is much more detailed than others as it must include accurate information about the staff member or patient’s injuries, where in the hospital it happened and what medical treatment they required.

Conclusion

As you write your workplace incident reports, remember it is not to place blame on one person, but rather record a series of events that have taken place. Sometimes these are pure accidents due to bad luck and, sometimes, there is human error or a technical fault involved. By the way, this is the basis of the Just Culture Algorithm™ which is definitely worth exploring if you’re looking to improve the safety culture at your workplace.

These examples of incident reports at the workplace are only the tip of the iceberg when it comes to the variety of workplace accidents that can occur. In any case, it’s crucial to record any incidents that arise because this helps create a safer work environment.

(Video) Accident Reporting In The Workplace Training | iHASCO

References & Further Reading

FAQs

What is an example of an incident in the workplace? ›

Examples of workplace incidents include: An accident. An injury. An illness.

How do you write a detailed incident report? ›

Step-by-step process to write an incident report
  1. Collect the information. The first step is to collect all the relevant information. ...
  2. Establish the order of events. Once you have collected all the information about an incident, you need to determine exactly what happened. ...
  3. Analyze the root cause. ...
  4. Formulate corrective action.

What are examples of incidents? ›

For example: By slipping and breaking an arm. By coming into contact with a corrosive chemical. By cutting themselves with a knife.

What is the most common workplace incident? ›

  • Slips, trips and falls. Falling over in general accounts for a large number of workplace injuries. ...
  • Manual work accidents. ...
  • Burns. ...
  • Vehicle collisions. ...
  • Repetitive motion injury.

What are the 4 types of incident reports? ›

Common Types of Incident Reports
  • Workplace. Workplace incident reports detail physical events that happen at work and affect an employee's productivity. ...
  • Accident or First Aid. ...
  • Safety and Security. ...
  • Exposure Incident Report.
12 Oct 2022

What are five 5 incidents that should be reported to work safe immediately? ›

Notifiable Incidents
  • Amputation (of ANY part of the body)
  • A serious head injury.
  • A serious eye injury.
  • Separation of skin from underlying tissue, such as de-gloving or scalping.
  • Electric shock.
  • Spinal injury.
  • Loss of a bodily function.
  • Serious laceration.

What are the 5 W's for an incident report? ›

Some months ago, I was hosting a weekly virtual class and talked about the 5Ws and 1H of writing — What, Why, Who, Where, When, and How.

What are the 6 elements of an incident report? ›

It should include:
  • the names and positions of the people involved.
  • the names of any witnesses.
  • the exact location and/or address of the incident.
  • the exact time and date of the occurrence.
  • a detailed and clear description of what exactly happened.
  • a description of the injuries.
24 Aug 2022

What are examples of reportable incidents? ›

Types of reportable injury
  • fractures, other than to fingers, thumbs and toes.
  • amputations.
  • any injury likely to lead to permanent loss of sight or reduction in sight.
  • any crush injury to the head or torso causing damage to the brain or internal organs.
  • serious burns (including scalding) which:
22 Mar 2022

What are the most common incidents? ›

Here are 10 of the most common accidents that can happen in the home and how to deal with them:
  • 1) Falling objects. ...
  • 2) Trips and Falls. ...
  • 3) Bruises. ...
  • 4) Sprains. ...
  • 5) Cuts. ...
  • 6) Burns. ...
  • 7) Choking. ...
  • 8) Poisoning.

What are the 4 main reasons for incidents at work? ›

Following are eight of the most common causes of accidents in the workplace:
  • Lifting. ...
  • Fatigue. ...
  • Dehydration. ...
  • Poor Lighting. ...
  • Hazardous Materials. ...
  • Acts of Workplace Violence. ...
  • Trips and Falls. ...
  • Stress.

What is a simple incident? ›

An incident is an occurrence or event that requires an emergency response to protect life, property or the environment. A simple incident may involve few resources, be located within a small geographical area and last for only a short period of time.

What are the 10 most common workplace accident and injuries? ›

The 10 most common workplace accidents in the Rhode Island are slip and fall, struck by a moving object, struck against stationary objects, overexertion, repetitive motion injuries, electrocution, entanglement, motor vehicle accidents, falls from heights and workplace violence.

What are 6 common workplace accidents? ›

What are the Most Common Workplace Accidents?
  • Cuts and gashes. ...
  • Burns. ...
  • Trips, slips, and falls. ...
  • Bodily reaction events. ...
  • Falls from heights. ...
  • Injuries from falling objects. ...
  • Overexertion accidents. ...
  • Incidents involving tools and machinery.

What are 4 of the 5 most common causes of workplace accidents? ›

Amongst the causes, five stood out as being the most common, with slips and trips being the single most common cause of injuries at work.
  • Hit by a moving object. ...
  • Fall from height. ...
  • Manual Handling. ...
  • Struck by moving vehicle. ...
  • Slips and trips.

What are the three C's of an incident report? ›

Training your brain before you find yourself in a high-pressure situation may help you save a life or potentially help someone in pain. There are three basic C's to remember—check, call, and care. When it comes to first aid, there are three P's to remember—preserve life, prevent deterioration, and promote recovery.

What is the most common type of incident reporting event? ›

Safety Incident Reporting

Safety incident reports one of the most common type of incident reports where the incident concerns an injury or illness or accident.

What are incident templates? ›

Incident templates consist of a name and message that can be used at a later time to pre-fill the name and message fields when creating an incident.

What is Incident Response Template? ›

An incident response plan template is a comprehensive checklist of the roles and responsibilities of an incident response team in the event of a security incident. It also describes the steps and actions required to detect a security incident, understand its impact, and control the damage.

What are three examples of types of information included on an incident form? ›

Tips For Reporting Incidents. Include essential information, such as identity of the person involved in the incident, the exact time and place of the incident and the name of the doctor you notified. Document any unusual occurrences that you witnessed.

How should incidents be reported in the workplace? ›

If you are concerned about any incident, minor or significant, call us for advice on 13 10 50. If there is a serious incident – what we call a 'notifiable incident' – call us immediately on 13 10 50.

What are four most common types of workplace accidents? ›

4 Common Types Of Workplace Accidents
  • 1) Slips and Falls. ...
  • 2) Manual Labor. ...
  • 3) Working With Heavy Equipment. ...
  • 4) Workplace Hazard. ...
  • Expensive medical bills and lost wages from being unable to work can greatly hurt your ability to support yourself.

What are 5 examples of unsafe conditions in the workplace? ›

Common types of unsafe working conditions
  • Lack of training.
  • Operating equipment without training or authorization.
  • Using defective equipment, such as power tools or ladders.
  • Failure to warn others about a safety hazard.
  • Operation of equipment in an inappropriate manner.
  • Workplace congestion.
  • Poor housekeeping.
  • Fire hazards.
15 Jan 2018

How do you write an incident report using 5w and 1H? ›

The Technical Writing Approach: The 5 Ws and 1 H

The 5Ws simply refers to the What, When, Where, Who, and Why of an incident and the 1H is the How of that event. If the answers to these questions are arrived at, the situation will be well understood enough to resolve a case.

What are the 5 W and H questions examples? ›

5 W's and H Questions
  • Who was involved?
  • What happened?
  • When did it happen?
  • Where did it happen?
  • Why did it happen?
  • How did it happen?

What is the golden rule of investigation? ›

It is consummated the moment the offender touches the body of the victim. In other words, touching is the operative act that would consummate the crime. Without the act of touching, there is no crime of acts of lasciviousness. Thus, there is no attempted nor frustrated acts of lasciviousness.

What is a good incident report? ›

Effective Incident Reports identify the facts and observations. They avoid inclusion of personal biases; they do not draw conclusions/predictions, or place blame. Effective Incident Reports use specific, descriptive language and identified the action(s) taken by staff as a result of the unusual incident.

What information should be in incident report? ›

The form should include the date and time of the incident, as well as the names of all those involved. The form should also list the sequence of events, and describe any injuries and damage sustained, only the essential information of the incident happened.

What are the 5 functional areas of incident command? ›

ICS establishes five functional areas for management of major incidents: command, operations, planning, logistics, and finance/administration. Span-of-control recommendations are followed closely, so the organizational structure is never larger than required.

What should not be included in an incident report? ›

An incident report should be objective and supported by facts. Avoid including emotional, opinionated, and biased statements in the incident report. It should provide both sides of the story and should not favor one side.

What is a Type 5 incident type? ›

TYPE 5 INCIDENT: One or two single response resources with up to 6 response personnel, the incident is expected to last only a few hours, no ICS Command and General Staff positions activated.

What is a Priority 1 reportable incident? ›

Priority 1 reportable incidents include those that cause, or could reasonably have been expected to have caused, physical or psychological harm and/or discomfort that would usually require some form of medical or psychological treatment, or where there are reasonable grounds to report the incident to police.

What types of workplace incidents are required to be reported and documented? ›

What incidents must be reported at the workplace?
  • The death of a person at your workplace (employee, contractor, visitor or otherwise)
  • A serious illness or injury.
  • A dangerous incident that exposed someone to a serious risk, even if there was no injury.

What are the 3 main work accidents? ›

The most common work injuries are slips, trips, and falls, overexertion, and contact with equipment. All of these injuries are mostly preventable by taking the proper precautions and adhering to OSHA's guidelines.

What are the 9 common accidents that may happen in the workplace? ›

10 of the most common workplace accidents and injuries
  • Slips, trips and falls. ...
  • Muscle strains. ...
  • Being hit by falling objects. ...
  • Repetitive strain injury. ...
  • Crashes and collisions. ...
  • Cuts and lacerations. ...
  • Inhaling toxic fumes. ...
  • Exposure to loud noise.
19 Jun 2022

What is the #1 workplace injury? ›

The three leading causes of work-related injuries treated in an emergency department were contact with objects and equipment, overexertion and bodily reaction, and falls, slips and trips without a fall.

What are the 3 basic causes of incidents? ›

Root causes of incidents are broken down into three levels: direct cause, indirect cause and basic cause.

What is a major incident examples? ›

Examples of major incidents include:-

Natural disasters such as floods and storms. Pollution ie spillages, radioactive substances, toxic gases. War or terrorism.

What is a good sentence for incident? ›

Example Sentences

Noun We just want to put that embarrassing incident behind us. Two people were shot yesterday in two separate incidents.

What is a Type 1 incident? ›

This type of incident is the most complex, requiring national resources for safe and effective management and operation. All command and general staff positions are filled. Operations personnel often exceed 500 per operational period and total personnel will usually exceed 1,000.

What is considered as incident? ›

The term incident can be defined as an occurrence, condition, or situation arising in the course of work that resulted in or could have resulted in injuries, illnesses, damage to health, or fatalities.

What is an example of a serious incident? ›

More Definitions of serious incident

serious incident means a disturbance at the facility involving 5 or more inmates or detainees, a death of an inmate or detainee, a felony or attempted felony committed within the facility, or an escape or attempted escape from the facility.

What are the 5 most common causes of workplace accidents? ›

Amongst the causes, five stood out as being the most common, with slips and trips being the single most common cause of injuries at work.
  1. Hit by a moving object. ...
  2. Fall from height. ...
  3. Manual Handling. ...
  4. Struck by moving vehicle. ...
  5. Slips and trips.

What should be reported as an incident? ›

What must be reported?
  • Deaths and injuries caused by workplace accidents.
  • Occupational diseases.
  • Carcinogens mutagens and biological agents.
  • Specified injuries to workers.
  • Dangerous occurrences.
  • Gas incidents.

Which is the best description of an incident? ›

An incident is an unexpected event that disrupts the normal operation of an IT service. A problem is an underlying issue that could lead to an incident. problem management consists of the measures taken to prevent the occurrence of an incident.

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