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.
Docustay is not for protected health information yet. Do not collect it with this template.
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 · Behavior · 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 template, the way the person you send it to fills it in.
In this template
What is on the page.
- About you: 3 fields
- What happened: 6 fields
- Injury or damage: 3 fields
- Afterwards: 5 fields
- Signature: 2 fields
- For supervisor use: 4 fields
It is your own copy in your workspace. Change any of it before you send.
Send it from code
Send the incident report template from your own code.
Make your own copy once, then send it to the person you name. A test key sends only to you.
npx docustay templates customize incident-report --name "Incident report"
# prints the new template's id; then send it as a test:
npx docustay send --test $DOCUSTAY_TEMPLATE_ID --party 'signer=Name <email>'curl -X POST "$DOCUSTAY_URL/api/v1/documents/send" \
-H "Authorization: Bearer $DOCUSTAY_API_KEY" \
-H "Idempotency-Key: $(uuidgen)" \
-H "Content-Type: application/json" \
-d '{"templateId":"$DOCUSTAY_TEMPLATE_ID","parties":[{"seat":"signer","name":"Name","email":"name@example.com"}]}'What you keep
A sealed copy and its record.
Each person who signs gets the sealed PDF with a certificate of completion, and so do you. Search them in your workspace and read each one by its own record.
Questions
Quick answers.
Who fills it in?
The person you send it to. They are the reporter in this template: they 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 send it to many people at once?
Yes. Send to a list sends your own copy to each person on it, and each person signs their own copy.
Can I change the questions?
Yes. In your workspace it is your own copy: add, remove or reword any field, then send it. The original is never changed.
Can people attach files?
19 fields make up the incident report template. Where it has a file box, people may attach a PDF or a picture, and it is stored exactly as they upload it and never converted.
Is this legal advice?
No. The incident report template is a starting point in plain words. Change what does not fit before you send it.
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