Incident report form
Record a site incident or injury properly: what happened, the injury, the immediate action, the root cause, and how you will stop it happening again. Print a clean form to fill in, or keep blanks on site. A notifiable incident must also go to your WHS regulator.
Leave the details blank to print a reusable form, or note a notifiable incident must also be reported to your WHS regulator.
Incident / Injury Report
Company: ______________________
Site: ______________________
Date of incident:
Time:
Person injured / involved:
Role / trade:
Exact location on site:
What happened (sequence of events):
Injury / damage sustained:
Immediate action taken:
Root cause / contributing factors:
Corrective action to prevent recurrence:
Reported by: ____________________
Signature / date: ____________________
swmspack.com · A notifiable incident (death, serious injury, or dangerous incident) must also be reported to your WHS regulator immediately.
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