---
title: Incident report form template, free
description: A free incident report form template. 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. Publish it as one link; every response is its own signed copy.
---

# 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.

Capture the facts while they are fresh, the same way every time, so they can be reviewed.

## About you

- Full name (text)
- Email (email)
- Phone (phone, optional)

## What happened

- Date (text)
- Time (text)
- Location (text)
- Type (choice)
- Description (text)
- People involved (text, optional)

## Injury or damage

- Anyone hurt (choice)
- Help given (text, optional)
- Damage (text, optional)

## Afterwards

- Immediate action (text, optional)
- Witnesses (text, optional)
- Photos or documents (file (PDF or picture), optional)
- Prevention (text, optional)
- The information I have given is true and complete to the best of my knowledge. (tick box)

## Signature

- Reporter signature (signature)
- Reporter date signed (date signed)

## For supervisor use

- Decision (choice)
- Note (text, optional)
- Supervisor signature (signature)
- Supervisor date signed (date signed)