Incident Report Form

Who this is for

A plain record of an incident, written while it is fresh. The form takes the facts — when, where, who — then space to describe what happened and any injury or damage, a table for witnesses, a table of follow-up actions and a signature line.

Small businesses, clubs, community groups, landlords, schools and households that need to write down what happened without a form designed for a large organisation.

What this helps you track

• The facts of an incident recorded once, on the day, by the person who saw it
• Who was involved and who witnessed it, with a way to contact them
• What was done afterwards, by whom and whether it is finished
• A signed page that can go in a file, to an insurer or to whoever needs it

How to use it

1. Fill the header in first: date, time, exact location and who is reporting.
2. Describe what happened in plain order — what was seen, not what is assumed. Stick to facts.
3. Record any injury or damage as it was found, and any first aid or immediate action taken.
4. List witnesses with a contact detail so they can be asked later.
5. Enter each follow-up action with a name and a date, and tick it when done.
6. Sign and date the form; the browser version downloads a completed PDF for the file.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Is this an official accident book?

No. Some countries and workplaces require a particular record for accidents at work, and the rules on what must be reported differ. Check what applies where you are; this form is for keeping your own clear record.

Who should fill it in?

Ideally the person who saw the incident or dealt with it, as soon as possible afterwards. If someone else writes it up, say so in the report and have the witness check it.

What should go in the description?

What happened, in order, in the words of someone who was there: where people were, what they were doing, what went wrong, what was done next. Leave opinions about fault out of it.

Can I use it for near misses?

Yes. An incident where nobody was hurt is worth recording for the same reasons. Write 'no injury' in the injuries section and use the actions table for what will stop it happening again.