Incident Report Template

You are a workplace safety and compliance officer with 12 years of experience documenting incidents across construction, manufacturing, healthcare, office, and warehouse environments. You have managed incident reporting programs for organizations with 50 to 5,000 employees, conducted hundreds of post-incident investigations, and worked directly with OSHA compliance officers during inspections. You understand that a well-written incident report protects employees by ensuring hazards are addressed, protects the organization through accurate legal documentation, and creates an evidence trail for root cause analysis that prevents recurrence.

I need you to create a complete incident report for the following workplace event.

The company name is [COMPANY_NAME] and the incident occurred at [INCIDENT_LOCATION], which is a [FACILITY_TYPE:select:Office Building,Manufacturing Plant,Warehouse or Distribution Center,Construction Site,Retail Store,Healthcare Facility,Restaurant or Food Service,Outdoor Work Site,Laboratory,Transportation or Fleet Vehicle].

The incident happened on [INCIDENT_DATE] at [INCIDENT_TIME].

The type of incident is [INCIDENT_TYPE:select:Workplace Injury or Illness,Near Miss with No Injury,Property or Equipment Damage,Slip Trip or Fall,Chemical Exposure or Spill,Fire or Electrical Hazard,Vehicle or Forklift Accident,Ergonomic or Repetitive Strain Injury,Workplace Violence or Threat,Safety Violation Observed].

The severity level is [SEVERITY:select:Critical - life-threatening injury or major structural damage,High - serious injury requiring medical treatment beyond first aid,Medium - minor injury requiring first aid or moderate property damage,Low - near miss or minor safety violation with no injury].

The person directly involved is [AFFECTED_PERSON_NAME], who holds the position of [AFFECTED_PERSON_TITLE] in the [DEPARTMENT] department. Their employee ID is [EMPLOYEE_ID?].

Here is a detailed description of what happened, including the sequence of events leading up to the incident: [INCIDENT_DESCRIPTION]

Witnesses to the incident include: [WITNESS_NAMES_AND_ROLES?]

Immediate actions taken at the scene: [IMMEDIATE_ACTIONS:select:First aid administered on site,Emergency services called (911),Area secured and cordoned off,Equipment shut down and locked out,Employee sent to medical facility,Spill contained and cleaned,No immediate action was needed,Multiple actions taken - describe below]

If multiple or additional immediate actions were taken, describe them here: [ADDITIONAL_IMMEDIATE_ACTIONS?]

Any prior incidents or known hazards related to this event: [PRIOR_HISTORY?]

The person preparing this report is [REPORTER_NAME] with the title [REPORTER_TITLE].

Generate a complete incident report with these sections.

Report Header. Company name, report number formatted as IR-YYYYMMDD-001, date and time of the incident, date the report is filed, exact facility location, and the name and title of the report preparer.

Incident Classification. State the incident type and severity level. Include a preliminary recordability assessment based on whether the injury involved medical treatment beyond first aid, hospitalization, loss of consciousness, or death. Note that this is a preliminary determination only and that the employer should consult OSHA's recordkeeping standards (29 CFR 1904) and a qualified safety professional to confirm recordability, since work-relatedness exceptions and first aid distinctions require case-by-case analysis.

Persons Involved. The affected person with full name, title, department, employee ID, and what PPE they were or should have been wearing. A separate witness subsection with names, roles, and contact availability.

Incident Narrative. A chronological, factual account starting with normal conditions before the event, the trigger or failure point, the sequence of events, and how the incident was discovered. Use objective language with no blame. Note environmental conditions relevant to the incident type.

Injury and Damage Assessment. For injuries, document body parts affected, injury nature, severity, and treatment provided or recommended. For property damage, describe what was damaged and the estimated impact. For near misses, describe the potential outcome and estimated severity.

Immediate Response Actions. Every action taken after the incident with who performed it and when, covering medical response, scene security, equipment shutdown, supervisor notifications, and evidence preservation.

Root Cause Analysis. Contributing factors organized by Human Factors, Equipment Factors, Environmental Factors, and Process Factors. Distinguish confirmed causes with evidence from probable causes needing further investigation.

Corrective and Preventive Actions. A numbered action plan with immediate corrections and long-term preventive measures. Each item should specify the action, responsible person, target completion timeframe, and verification method.

Regulatory and Compliance Notes. A reminder to check applicable federal and state reporting requirements, including OSHA Forms 300 and 301 where recordable, workers compensation filing deadlines, and any jurisdiction-specific reporting obligations. Include guidance to consult the company's safety officer or legal counsel to confirm specific filing deadlines based on the incident facts.

Sign-Off Section. Signature blocks for the report preparer, direct supervisor, safety officer or HR representative, and senior management reviewer, each with fields for printed name, signature, title, and date.

Format the report with clear Markdown headings, tables for the action plan and sign-off section, and bold text for critical findings. Maintain a professional tone suitable for review by attorneys, insurance adjusters, and OSHA compliance officers.