Incident Report Form
Capture an incident properly on the day, in the affected person's own words, with the witness details and equipment notes that become impossible to gather later.
IN-03 2 pages
Incident and first aid records · IN-04
Accident Book Page
A free printable single-page accident record — the person, the accident in their own words, the injury, what was done and who recorded it.
Download Free · no sign-up
One page. Choose your paper size — both versions are laid out identically, so neither one gets shrunk to fit.
Print it and write on it
Fill it in type and save
The fillable versions have real form fields — open them in any PDF reader, type into them and save. Printing help.
What this sheet is for
Record one accident on one page, so the completed record can be filed securely rather than left in a book for the next person to read.
Who it is for
Small employers, clubs, halls, shops, schools, care settings and any premises where an accident might happen to a visitor.
How to use it
- Complete it the same day, in the injured person's own words where possible.
- Read it back to them before anyone signs.
- File the completed page securely, separately from the blank ones.
- Complete any formal report your local rules require as well.
- Review the pages together periodically — patterns show across them.
What is on the sheet
One page, top to bottom:
Printed under the title: One accident, on one page, so the completed record can be filed securely instead of read by the next person.
One page per entry, filed securely. One page per entry is deliberate. A bound book leaves everybody's details on show to whoever fills in the next line, and in many countries the personal information on it has to be kept confidential. What must be recorded and reported, to whom and how long it must be kept differ by country — this page names no scheme.
The person
Write-on lines: Full name · Date of birth, if required locally · Address · Occupation or reason on site
The accident
Write-on lines: Date · Time · Where exactly · Reported to
Ruled lines: What happened, and what the person was doing — in their own words where possible
Write-on lines: Injury or effect · Treatment given, and by whom · Taken to hospital · Sent home · Returned to work · Witnesses named overleaf
Completed by
Write-on lines: Name · Signature · Date · On behalf of the injured person
Questions
Why single pages rather than a bound book?
Because a bound book shows everybody's personal details to whoever fills in the next line, and in many countries that information has to be kept confidential. Separate pages can be filed away as soon as they are complete.
Does completing this discharge a reporting duty?
No. What must be reported, to whom and within what time differ by country and by the kind of premises or work. This page names no scheme — check what applies to you and keep this alongside whatever that requires.
Related sheets
First Aid Treatment Log
Keep a running record of first aid given so that supplies used and patterns of injury are both visible in one place.
IN-05 1 page
Near Miss Report Form
Capture the things that nearly went wrong, in a form that asks what happened rather than who was at fault.
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Also in the resources library
The same subject, with a version you can fill in on screen.
Falls and Concerns Record
Every fall, near miss or concern with the date, time and place.
CS-286 Record PDF Excel Online
Incident Report Form
The facts of an incident recorded once, on the day, by the person who saw it.
SF-98 Form PDF Online
