Incident report form: who, what, when and where
After an incident, details fade quickly. This form asks for the reporter's name and role, the date and time, the location, the severity (near miss, minor, serious or critical), a description of what happened, whether anyone was hurt and how, the names of witnesses, an optional photo and a signature.
Who it is for
- Small businesses, workshops and shops
- Schools, clubs and event organisers
- Site managers and facilities teams
When to use it
Have people complete it as soon as possible after the event, on a phone or a tablet. The severity scale helps you decide what needs attention first, and recording near misses can help prevent a real accident later.
What the form asks
Who is reporting
- Your name · requiredShort text
- RoleShort text
The incident
- Date · requiredDate
- TimeTime
- Location · requiredShort text
- Severity · requiredMultiple choice
- Describe what happened · requiredLong text
- Was anyone injured? · requiredYes / No
- Who and how?Long text
- Witnesses (names and contact)Long text
- Photo (PNG or JPEG)Image upload
- Signature · requiredSignature
Every question can be changed, removed or reordered before you publish.
The PDF your respondents receive
The PDF is a signed, dated report with the photo included. It is a useful record to keep in your files or to pass to an insurer, a safety officer or the authorities when required.
Questions people ask
- Does this meet my legal reporting duties?
- It helps you record facts, but legal duties vary by country and sector. Check what applies to you.
- Can several witnesses be listed?
- Yes. The witnesses question accepts several names and contact details in one answer.
- Who can see the reports?
- Only you, as the owner of the form, and anyone you share the PDF with.
Start from this template
Create an account, adapt the questions and the document to your business, then share the link. Your respondents get their PDF the moment they finish.