Incident Report Form
An incident report that captures the account while it is fresh: what type of incident occurred, the timeline, witnesses, injuries, scene photos, and an optional recorded verbal statement.
Who uses it and how often
- Used by
- Safety officers, supervisors, and anyone responsible for incident documentation.
- Frequency
- Immediately after any incident, near miss, or property damage event.
The checklist (13 questions)
Incident capture built around recorded statements, photos, and dictation.
- 01
Person involved
Short textRequired - 02
Date of incident
DateRequired - 03
Location of incident
Short textRequired - 04
Incident type
Options: Fall · Injury · Property damage · Near miss · Behavioral · Other
Multiple choice (choose several)Required - 05
Recorded witness statement
Audio / voice noteOptional - 06
Reporter statement
Dictate or type what happened, in sequence.
Long textRequired - 07
Photo of the scene
Photo / cameraOptional - 08
Video of the scene
Video / cameraOptional - 09
Were there any injuries?
Yes / No / N/ARequired - 10
Were emergency services contacted?
Yes / No / N/ARequired - 11
Immediate actions taken
Long textRequired - 12
Supervisor notified within policy timeframe?
Yes / No / N/ARequired - 13
Reporter signature
SignatureRequired
How to run this inspection
- 01
Select the incident type and record the date, time, and location.
- 02
Photograph the scene before it is disturbed.
- 03
Record the verbal statement of the person involved and any witnesses.
- 04
Document injuries, immediate actions taken, and follow-up owner.
Run it on a phone instead of paper
Open this checklist in FormFlow QA to schedule it against your sites, assign it to your team, attach photos and signatures, and keep every submission encrypted and searchable. There is a free plan during beta.