FORM TEMPLATE · Operations
Incident report
What happened, when and where, who was involved, any injury or damage, what was done straight away, with witnesses and photos, reviewed by a supervisor.
Report what happened as soon as you can, in plain words. Stick to what you saw and heard. In an emergency, call the emergency services first.
About you
- Full nametext
- Emailemail
- Phonephone, optionalOptional. Used only to reach you about this form.
What happened
- Datetext
- Timetext
- Locationtext
- TypechoiceInjury · Near miss · Damage to property · Security or safety concern · Behaviour · Other
- Descriptiontext
- People involvedtext, optionalNames and roles, if known.
Injury or damage
- Anyone hurtchoiceYes · No
- Help giventext, optionalDescribe what was done. Do not attach medical records.
- Damagetext, optional
Afterwards
- Immediate actiontext, optional
- Witnessestext, optional
- Photos or documentsfile (PDF or picture), optionalA PDF or a picture (PNG or JPEG). It is kept exactly as you upload it.
- Preventiontext, optional
- The information I have given is true and complete to the best of my knowledge.tick box
Signature
- Reporter signaturesignature
- Reporter date signeddate signed
For supervisor use
- Decisionchoice · SupervisorReviewed · no further action · Reviewed · action taken · Escalated
- Notetext, optional · SupervisorOptional. Shown on the signed copy.
- Supervisor signaturesignature · Supervisor
- Supervisor date signeddate signed · Supervisor
What people see
The form, the way the person with the link fills it in.
Incident report
Report what happened as soon as you can, in plain words. Stick to what you saw and heard. In an emergency, call the emergency services first.
About you
What happened
Injury or damage
Afterwards
Signature
For supervisor use
19 fields for the person filling it in, plus 4 for the team member.
What people agree to
The wording beside each box.
- The information I have given is true and complete to the best of my knowledge.
When you publish
It starts with these settings.
- People sign without an email check.
- Someone on your team counter-signs each response.
- No limit on responses.
- After signing, people can start another response.
- You get an email for every signed response.
- The person gets an email with their signed copy.
Change any of them on the Publish step before the link goes live.
Questions
Quick answers.
Who fills it in?
Anyone with the link. They are the reporter in this form, type their own name and email, fill in each box and sign. Then the supervisor you choose on your team adds a decision and counter-signs.
Can I change the questions?
Yes. In your workspace it is your own copy: add, remove or reword any field, then publish it. The original is never changed.
Can people attach files?
Where the form has a file box, people may attach a PDF or a picture. It is stored exactly as they upload it and never converted.
Is this legal advice?
No. It is a starting point in plain words. Change what does not fit before you publish it.
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