Free Workplace Accident Report Form Templates, Checklists, and Samples

Smartsheet Contributor Andy Marker

September 19, 2019

In this article, you’ll find a wide selection of ready-to-use workplace incident report templates that you can tailor to fit your needs. These free templates are available for download in Word, Excel, and PDF formats. 

Included on this page, you will find an employee incident/accident report form, a supervisor's incident investigation report template, a statement of witness to accident template, an employee's return to work plan, and many more helpful workplace accident report forms.

Employee’s First Report of Injury Form Template

Employee First Report of Injury Form Template

When an employee is involved in a work-related accident or illness, the employer is responsible for filing the first report of injury (FROI) to begin the claims process. This customizable FROI template comes ready for employees to enter personal information, the type of accident, the names of all witnesses, the incident location, prevention suggestions, the contact information of the employee’s physician, and more. 

Download Employee’s First Report of Injury Form Template

Word | PDF | Smartsheet

Employee’s Incident/Accident Report (with Back Injury Report) Template

Employee Incident Accident Report Template

The injured employee should fill out this pre-built employee incident/accident report (it also includes a back injury report, if applicable). Use this template to collect the injured employee’s personal information and the circumstances of the accident, including the duties the employee was performing at the time of the event, the objects or machinery involved, the severity of the injury the employee sustained, and the medical care they received. The document also includes a section for the employee to sign a medical release. 

Download Employee’s Incident/Accident Report (with Back Injury Report) Template

Word | PDF | Smartsheet

Workplace Incident Report Form Template

Workplace Incident Report Form Template

At the workplace, when a hazardous occurrence arises that has the potential to cause bodily injury, health issues, or even fatalities, you should file a workplace incident report immediately, so authorities can determine if further investigation is necessary. This incident report form template provides space to record all employees involved in the incident, identification numbers of equipment involved, incident event details, and injury and first aid details. 

Download Workplace Incident Report Form Template

Word | PDF | Smartsheet

Work-Related Accident/Injury Report Form Template

Work Related Accident Injury Report Form Template

You should complete a work-related injury report as soon as possible after sustaining an injury and immediately submit it to HR for processing. The supervisor should make sure they complete the injury report if the employee involved in the accident is physically unable to do so. This customizable work-related accident/injury report form template tracks the employee’s personal and professional information, key details surrounding the accident, affected parts of the body, first aid administered at the scene of the injury, medical provider information, and signatures for both the employee and supervisor. 

Download Work-Related Accident/Injury Report Form Template

Word | PDF | Smartsheet

Supervisor’s Incident Investigation Report Template

Supervisors Incident Investigation Report Template

In addition to filing an employee incident or accident report, the supervisor will need to file an incident investigation report in order to collect facts, determine the supreme cause of the accident, and implement corrective actions. This pre-built incident investigation report organizes information into sections, with space to document the employee’s information and injury details, a description of the event, all witnesses of the incident, any unsafe work conditions, future incident prevention suggestions, the investigation team member names, and more.  

Download Supervisor’s Incident Investigation Report Template

Word | PDF | Smartsheet

Supervisor’s Report of Return to Work Template

Supervisor's Report of Return to Work Template

Once you have filed a workplace accident report and a medical care provider has assessed the employee’s injuries, the supervisor submits a return to work plan to the workers’ compensation coordinator. This customizable return to work template provides space to record the employee’s name, the date of return, and the status of the employee’s work status, including whether the organization will place restrictions on such employee or deem them ready to work their full schedule.

Download Supervisor’s Report of Return to Work Template

Word | PDF

Employee’s Return to Work (RTW) Plan Template

Employee Return to Work Plan Template

The relevant supervisor should complete the employee return to work plan and submit it to the employee and the workers’ compensation coordinator for filing. Once a physician has provided medical feedback pertaining to the employee’s injuries and limitations, a supervisor can use this pre-built template to schedule a return to work date, check off key requirements to review or brief relevant parties on, and organize a weekly work plan to successfully transition the employee back into the workplace.

Download Employee’s Return to Work (RTW) Plan Template

Excel | Word | PDF | Smartsheet

Statement of Witness to Accident Template

Statement of Witness to Accident Template

A witness statement to an accident can aid in the investigation of a hazardous event and help prevent similar incidents in the future. It is crucial to encourage witnesses to submit statements as soon as possible following an accident, while the details are still fresh in one’s mind. Use this statement of witness to accident template to track key details, including the name of the employee involved and the contact information for the witness. The document includes ample space for the witness to recount the event details.  

Download Statement of Witness to Accident Template

Word | PDF | Smartsheet

Near-Miss Report Form Template

Near Miss Report Form Template

You can use this pre-built near-miss report form template to record particulars regarding an incident that had the potential to cause an injury, death, or illness. This template tracks the location of the close call, the workplace conditions, the type of concern, a description of the incident, any safety suggestions, and more. The form provides the employer with a clear picture of the event circumstances, so you can develop a plan of action to prevent future incidents.

Download Near-Miss Report Form Template

Word | PDF

Employee Incident Log Template

Employee Incident Log Template

According to OSHA, employers must retain records of employee injuries and illnesses for a minimum of five years. Maintaining a running log of these workplace incidents in one central location will ensure that you’re tracking and accounting for all reports. This downloadable employee incident log template provides space to record the claim number, employee identification number, incident date, location, and severity (e.g., death, injury, or near miss) and tracks the number of days away from work, the number of modified duty days, and the date returned to full duty for each affected employee.

Download Employee Incident Log Template

Excel | Smartsheet

Workplace Violence Incident Report Template

Workplace Violence Incident Report Template

This workplace violence incident report template is for the victim of a verbal threat or an act of physical violence. The victim should complete the report. This template tracks key incident details, including the name of the person(s) demonstrating the prohibited behavior, the name of the victim, incident witnesses, events leading up to and during the incident, plan of action recommendations, police report information, and more.  

Download Workplace Violence Incident Report Template

Word | PDF | Smartsheet

Health and Safety Incident Report Form Template

Health and Safety Incident Report Form

Use this pre-built health and safety incident report form to record dangerous incidents at the workplace, including diseases, illnesses, and safety hazards. Affected employees, contractors, and visitors to the worksite should fill out this form immediately following an occurrence to report the incident details, outcomes, first aid provided, corrective measures, and other information about the event.

Download Health and Safety Incident Report Form Template

Word | PDF

General Staff Incident Report Form Template

General Staff Incident Report Form Template

This ready-to-use general staff incident report form template includes room to report employee information, incident description details, an employee explanation, any witness names, and actions to be taken (e.g., verbal warning, probation, or dismissal). It also includes space at the bottom for signatures.  

Download General Staff Incident Report Form Template

Word | PDF | Smartsheet

Work Accident Report Sample Letter Template

Workplace Accident Report Sample Letter

Notifying your employer in a timely manner following a work-related injury is crucial if you plan to file a workers’ compensation claim. Customize this work accident report sample letter to suit your needs, and then submit it to your employer within the notification time frame required by your state. This template also includes space for you to add incident details (including events leading up to the incident), names of witnesses, treatment received following the incident, work restrictions, and more.

Download Work Accident Report Sample Letter - Word

Claim Tracking Checklist Template

Claim Tracking Checklist Template

The process for filing and maintaining workplace accident claims requires a tightly managed recordkeeping system. Use this claim tracking checklist template to track the status of claim certification approvals, agency authorities you’ve notified, and essential reporting documentation that you need (e.g., employee’s accident report, supervisor’s investigation report, witness statement form) for each injured employee to ensure that you account for and complete every step in the claim process.

Download Claim Tracking Checklist Template

Word | PDF | Smartsheet

What Is an Accident or Incident Report Form?

An accident report or incident report is a form that an employee or manager fills out in the case of an injury, illness, or near miss at the workplace. The terms accident and incident are often used interchangeably; however, an accident report places more emphasis on an injury sustained, whereas an incident report focuses more on the cause of an event and how an employer can prevent it in the future. You should submit an incident report even if an employee did not sustain an injury.

What Should Be Included in an Accident or Incident Report?

When an employee is involved in either a work-related incident or an accident involving an injury, you should include the following information in the report:

  • The affected employee’s information
  • The details of the incident (including the date, location, and description of the event)
  • The parts of the body affected (if an injury occurred)
  • The immediate actions taken to remedy the situation (including medical intervention)
  • The equipment malfunctions or other hazardous conditions that contributed to the incident
  • Witness statements
  • The information and evidence you gathered (including drawings and photographs)
  • The injuries or other medical issues that occurred due to the incident
  • Suggestions for the prevention of future incidents

What Is an Accident Reporting Procedure?

An accident reporting procedure is the process a company uses to communicate and document illnesses, injuries, and near-miss incidents that occur at the workplace. Employers are responsible for establishing a company policy for reporting incidents so that you can record, investigate, and correct work-related accidents and illnesses. 

Here is an example of an incident reporting process:

  1. The employee (or supervisor, if the employee is unable) should fill out the incident report in a timely manner, while the details are still fresh in their mind.
  2. Witnesses of the event should submit a statement to aid in the potential investigation of the incident.
  3. If applicable, you should take supporting photographs and/or create drawings to attach to the report.
  4. You should immediately notify employees, contractors, and visitors to the site of safety hazards in order to avoid additional incidents. 
  5. You should update policy documents to reflect the procedure for handling a repeat incident or preventing it in the future. 
  6. Ensure that all employees have access to the latest version of the accident reporting company policy.

Accident Reporting Company Policy Sample Template

Accident Reporting Company Policy Sample Template

You can customize this accident reporting company policy sample template according to the needs of your organization. You can use this template as a basis to build out your company’s accident reporting policy. It includes room to outline the policy’s purpose, scope, elements, insurance coverage information, emergency assistance instructions, incident reporting procedures, and more.

Download Accident Reporting Company Policy Sample Template

Word | PDF

Why Is It Important to Report Accidents at Work?

Reporting a work-related injury, illness, death, disease, or other hazardous occurrence is a legal requirement. The report assists the Health, Safety, and Environment (HSE) authorities and other local agencies by identifying — and potentially investigating — the location and cause of certain risk factors. By reporting an accident that you were directly involved in, or were a witness to, you are providing your employer with the information necessary to administer potential claims/lawsuits, identify risks, and develop solutions to prevent future occurrences.

What Are the Benefits of Using Incident Reporting Software That Contains Digital Reporting Forms?

In an increasingly technological society, now, more than ever, we have access to a vast selection of online tools and software that submit, manage, and securely store digital incident reporting forms and documentation. Here are some of the major benefits of migrating to an online incident management system that contains digital reporting forms:

  • With the click of a button, you can submit ready-to-use forms that are received instantly by the relevant party. 
  • The ability to submit images, drawings, and other supporting documents aids risk assessments and incident investigations.
  • In minutes, you can update policy documents and forms to the latest versions.
  • Built-in communication features allow you to connect with other devices at any time in order to conveniently exchange information.
  • Employees can easily access resources (e.g., procedures, checklists, and reporting forms) in a centralized, online location. 

In order to reap the benefits of incident reporting software, it is imperative to know which features to look for. Below, we’ll discuss the seven necessary components of an effective workplace incident management system.

What to Look for in a Workplace Incident Management System

Here are the seven key elements to look for when selecting an incident management system for your organization:

  • Forms, policies, and other resources are available across multiple mobile devices, so employees can easily access them out in the field. 
  • The system reflects form submissions and policy updates in real-time.
  • The system is user-friendly, technologically accessible to all personnel.
  • The system offers quick and easy installation for fast implementation.
  • The system provides built-in communication features, so you can quickly connect and correspond with stakeholders. 
  • Digital forms are readily available and customizable to suit your needs.
  • The system offers flexible pricing options to ensure that you are only paying for what you need.

With all of these components in mind, how do you begin to find the right incident management software for your business? We’ve done the research for you and uncovered the top accident reporting software systems that provide the highest value.

Top 13 Accident Reporting Software Solutions for Any Business

Below are the top incident management software solutions that provide the most value for your organization:

  1. Smartsheet: Smartsheet is a powerful and versatile work management tool that accelerates team throughput by fostering collaboration, accountability, and transparency. Easily create and distribute custom surveys and work accident forms to employees, contractors, and other personnel at the worksite for the purpose of data collection in real time, across multiple devices. Track the status of claims, attach images and documents, automate workflows, request approvals, analyze performance metrics on a widget-driven dashboard, report on incident data to stakeholders, and create a centralized hub for employees to access key resource links. 

    Pricing: Flexible pricing options start at $14/month for individual users and $25/month per user for a business plan. Compare plans and features to find the best fit for your needs. You can also start a free 30-day trial and even request a free demo.
  2. Connecteam: Connecteam is a user-friendly workforce management app that encourages team engagement. Create accident procedure checklists, send custom push notifications, communicate through the in-app chat feature, and more. You can also send, receive, and easily track the status of incident-related notes from employees, contractors, and other workers connected to your organization. 

    Pricing: Fixed monthly pricing ranges from $29 to $72 per month, for up to 200 users. A plan is available for businesses needing access for more than 200 users, but you will need to contact the company directly for additional pricing information. You can also start a free 14-day trial. 
  3. Typeform: Typeform is a web-based platform you can use to create surveys, forms, and questionnaires in order to collect information from employees regarding workplace hazards. For accident reporting, you also have the option of selecting and customizing pre-existing form templates for distribution to all personnel at a worksite. 

    Pricing: There are three price plan options, including Essentials (which is free with very limited features), Pro for $35/month per user, and Premium for $70/month per user.
  4. Freshservice: Freshservice is a cloud-based IT service management (ITSM) platform that focuses on helping an organization solve its internal IT challenges. You can open incident tickets through a variety of channels (e.g., email, phone, and service portal); then, your IT department can assign tickets and issue a custom canned response.

    Pricing: There are four monthly pricing options available, including $29/month per user, $59/month per user, and two plans at $99/month per user, for bigger teams and enterprises. You can also start a free 21-day trial. 
  5. A1 Tracker: A1 Tracker is a web-based asset management software that you can use to administer incident forms, electronic claims, reports, and more. You can also track the status of incidents, assets, and injuries, with additional features like risk notifications and location reporting. 

    Pricing: Contact a customer service representative for a customized quote. 
  6. ServiceDesk Plus: ServiceDesk Plus is web-based asset management software that serves as an IT help desk. You can use it to manage trouble tickets, contracts, IT assets, and reporting, and it includes multi-site support features.

    Pricing: Contact a customer service representative for a customized quote. 
  7. Incy.io: This is a semi-automated tool that allows employees to report an incident from a mobile device. Report forms are customizable: you can choose users to receive automated email notifications, and you can assess and analyze risk data for trends. 

    Pricing: Contact a customer service representative for a customized annual fee. 
  8. PagerDuty: PagerDuty is an incident response platform for an organization’s IT department. Use this app to create and track the status of incident tickets, event details, documentation, and more, with additional features like email and push notifications. 

    Pricing: Pricing plans start at $10/month for up to six users, $29/month per user for teams, and $39/month per user for businesses. You can also start a free 14-day trial. 
  9. VictorOps: VictorOps is an incident management and IT alerting platform that manages on-call scheduling, live call routing, and incident reporting. Users can attach relevant documentation to alerts to keep information in one place. 

    Pricing: Pricing plans range from $9/month per user to $49/month per user, or you can get a custom quote depending on your business needs. You can also try it free with a 14-day trial. 
  10. Compliance360: Compliance360 is a risk and compliance management tool that allows businesses to track and report on incidents, conduct internal audits, and manage policies. It also has two applications for gathering and administering disclosure forms that employees submit for review and approval. 

    Pricing: Contact a customer service representative for a custom quote. 
  11. Adashi Systems: Adashi Systems is a scheduling solution system that emergency service and law enforcement organizations use for dispatching, field reporting, and incident mapping. Other features include time and attendance tracking, real-time collaboration, and resource management for large-scale disasters.

    Pricing: Contact a customer service representative for a custom quote. 
  12. ProcessMAP: ProcessMAP is a web-based incident management solution that offers claims management, audit management, and incident tracking capabilities. You can also use the built-in calendar to assign tasks and gain performance visibility with dashboards.

    Pricing: Contact a customer service representative for a custom quote. 
  13. OnPage: OnPage is an incident management system that features task and ticket management, incident reporting, auditing, and root-cause diagnostics. Users can track incident ticket status, enable redundant messaging, and manage on-call schedules. 

    Pricing: Contact a customer service representative for a custom quote. You can also start a free 7-day trial.

Streamline Data Collection with Smartsheet Workplace Accident Report Forms

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The Smartsheet platform makes it easy to plan, capture, manage, and report on work from anywhere, helping your team be more effective and get more done. Report on key metrics and get real-time visibility into work as it happens with roll-up reports, dashboards, and automated workflows built to keep your team connected and informed. 

When teams have clarity into the work getting done, there’s no telling how much more they can accomplish in the same amount of time. Try Smartsheet for free, today.

 

 

 

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