Workplace Incident Report Form
Prompt incident documentation helps employers preserve facts, identify witnesses, record immediate actions, and coordinate follow-up without relying on memory days later.
Resource Snapshot
A local-only, fillable incident report form for supervisors documenting workplace injuries and near misses.
- Format: Interactive form
- Audience: Supervisors, HR, Safety managers
- Time: 8-12 minutes
Who Should Use This
- Front-line supervisors after an injury or near miss
- HR or safety teams collecting internal documentation
- Operations leaders reviewing corrective actions
When To Use It
- As soon as the employee is safe and urgent care decisions are complete
- Before facts become unclear or witness details are lost
- Before OSHA, workers' compensation, or internal safety review steps are started
What It Includes
- Incident and reporting details
- Witnesses, task, equipment, and environmental notes
- Immediate actions, first aid, referrals, testing consideration, and follow-up ownership
- Supervisor, HR, and safety sign-off fields
Common Mistakes And Cautions
- Document facts rather than assumptions or blame.
- An internal incident report is not the same thing as an OSHA 300 Log entry.
- Avoid unnecessary medical detail in broadly shared copies.
Resource Preview
Fill locally, print a completed version, or print a blank copy for supervisors.
Castellan Health Employer Resource
Workplace Incident Report Form
A local-only, fillable incident report form for supervisors documenting workplace injuries and near misses.
Disclaimer: This form is an internal documentation aid. It is not legal advice, medical advice, an OSHA determination, or a substitute for employer-specific workers' compensation, privacy, or safety procedures.
This resource uses 31 local fields or checklist items. Values stay in your browser session and are not stored by Castellan Health.
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Incident Report Form FAQs
What should be included in a workplace incident report?
Include the date, time, location, people involved, witnesses, factual description, task, equipment, body part affected, immediate actions, referrals, restrictions, and follow-up owner.
Who should complete the incident report?
Usually the supervisor or designated safety contact completes it, with HR or safety review when company policy requires it.
Is an incident report the same as the OSHA 300 Log?
No. An incident report is internal documentation. OSHA recordkeeping requires a separate recordability review based on the specific facts and applicable OSHA criteria.
Should medical details be included?
Keep medical details limited to what is needed for workplace documentation and routing. Avoid unrelated history or sensitive details in broadly shared copies.
How soon should an incident be documented?
Document as soon as practical after immediate safety and medical needs are handled, ideally during the same shift.
Need help turning this into an employer workflow?
Castellan Health can help employers coordinate injury care, drug testing, OSHA documentation, return-to-work communication, and occupational medicine services.