Incident report form: an example with all the fields you need

What belongs on an incident report form?

An incident report form is the first record of an event that caused, or could have caused, injury, damage or environmental impact. It answers five questions: what happened, where and when, who was there, what was the consequence and what was done straight away. Anything that goes deeper, such as the cause and the measures, comes later.

A report is not the same as an investigation. The report is the trigger and takes the reporter two minutes. The investigation then looks for the root cause and chooses measures, which is covered in our guide on incident investigation with the 5 whys method. Here the focus is on the form that starts it all.

Which types of report do you distinguish?

Let the reporter choose from a short list, so that they do not have to judge how serious something was. The type of report decides who receives it and which follow-up questions you ask. Injury calls for extra care, and a leak or spill is handled as an environmental report.

• Accident: there is injury, even if it is minor
• Near miss: nothing happened, but it could have
• Hazardous situation or act: a risk you see before anything happens
• Damage: to equipment, a vehicle, a building or somebody else's property
• Environmental incident: a leak, spill, emission or waste deviation
• Other: something that fits nowhere else, with room for an explanation

Example incident form, part 1: the fields for the reporter

The reporter fills in this part at the place where it happened, preferably on their phone. Stick to nine fields that everyone understands without explanation. Someone who sees twenty fields will not report next time. Use dropdown lists where you can, and allow the description to be spoken instead of typed.

• Type of report: accident, near miss, hazardous situation, damage or environment
• Date and time, prefilled with the moment of reporting
• Location or project, from a dropdown list, with a photo of the spot if wanted
• What happened? A short description in the reporter's own words
• Consequence: nothing, injury, damage or environmental impact
• Who was involved and who saw it happen
• What was done straight away, such as cordoning off the area or stopping the machine
• Photos or a video of the situation
• Name and contact details of the reporter, or anonymous

Example incident form, part 2: completed by the handler

The handler completes the rest, usually the line manager, the HSE coordinator or the prevention officer, after a conversation with the reporter. This part decides how deep you go. Injury details are health data: limit who can see them and do not record diagnoses that you do not need for the register.

Pay attention to the field for the reporting duty. An accident in which someone is admitted to hospital, even for a day, suffers permanent injury or dies must be reported immediately to the Netherlands Labour Authority. This also applies to agency workers and self-employed people working for you. Check the current rules on arbeidsinspectie.nl.

Assess the severity in two ways: the actual outcome and the outcome it could have had. In this example you use four levels: low (no injury or damage), medium (first aid or minor damage), high (absence, hospital or major damage) and critical (life-threatening or irreversible). For the risk itself you can use a method such as Kinney & Wiruth.

• Severity and potential: what was the outcome and what could it have been
• Injury: type, body part, treatment and absence, with restricted access
• First cause: circumstances, actions or organisation
• Reporting duty to the Netherlands Labour Authority: yes or no, and when reported
• Investigation needed: no, a short conversation or a full investigation
• Follow-up actions with an owner and a deadline
• Feedback to the reporter: what was done and when
• Closed by whom and on what date, plus a check that the measure works

A completed incident report as an example

As an illustration, a fictional report from construction. While working on a scaffold, a fitter drops a torque wrench of about a kilo. It lands on a walkway where a colleague had been walking an hour earlier. Nobody was hit. This is what the completed report could look like, with figures and deadlines used only as an example.

• Type: near miss, yesterday at 2.20 pm, office renovation project, ground floor
• Description: torque wrench fell from the second scaffold level onto the walkway below
• Consequence: no injury and no damage
• Done straight away: wrench picked up and the area below the scaffold cordoned off
• Severity: low in outcome, high in potential, because a fall from this height can cause serious injury
• First cause: no tool lanyard and the walkway below the work area was not cordoned off
• Reporting duty to the Labour Authority: no
• Actions: tool lanyards mandatory for work at height, cordon off the zone below scaffolds, topic in Monday's toolbox
• Feedback: the reporter hears within three working days what has been decided

Who fills in the form, and how do you make reporting easy?

Everyone who sees something must be able to report: the person affected, a colleague, a manager, but also agency workers, subcontractors and visitors. An account is often a barrier for them. A QR code at the workplace, in the van and in the canteen opens the form in the browser without logging in, and an app that stores a report until there is signal again prevents reports from getting lost on site.

Offer anonymous reporting, especially in the early stages and for sensitive topics. The drawback is that you cannot ask follow-up questions and cannot give the reporter personal feedback. The goal remains that reporting under your own name feels safe, and our guide on reporting culture explains how to get there.

What happens after the report?

A form is only valuable if something is done with it. Agree a fixed route and record who acts at each step. ISO 45001 expects you to respond to incidents in good time, investigate the cause, take measures and check that they work, and VCA expects accidents, near misses and hazardous situations to be reported, investigated and followed up. You can adopt this route.

Do not forget the feedback. Reporters want to know that someone has looked at their report, and a message of two sentences about what has been decided is enough. Also show the result to the team, for example in the toolbox talk or work meeting, with the message that the improvement came from a report. That is how people learn that reporting pays off.

• Acknowledge the report, preferably the same day, and thank the reporter
• Take immediate measures in case of acute danger and make the area safe
• Assess the severity and the potential and decide how deep to investigate
• Investigate the cause, with a full investigation for a high risk or repeat
• Record measures with an owner and a deadline
• Tell the reporter what has been done
• Close only after checking that the measure works
• Review the trends regularly by type, location and activity

Common mistakes with an incident form

Most forms fail not because of missing fields but because of too many fields and because of what happens after submission. A report that is left without a response costs you all the reports that would have followed. If you recognise any of these points, it pays to tighten your form and your route.

• Too long: the reporter has to fill in twenty fields before they can submit
• A blame question in the form, such as a field for who caused it
• Letting the reporter decide the severity, when the handler is better placed to do so
• Reports without feedback, which makes people stop reporting
• Recording only accidents and ignoring near misses
• Injury details visible to everyone in a shared overview
• A form that only works on a PC in the office

Incident report form on paper or digital?

Paper works at a location where everyone knows the form and there is a fixed drop-off point. The drawback is that reports get stuck, handwriting is hard to read and you have to retype trends by hand. An Excel list only partly solves that, because the reporter cannot see what happens to their report.

A digital form with photos, automatic notification and an overview of open reports makes follow-up visible and shows you trends without retyping. Choose what your people will actually use: a fitter in a van reports faster from their phone than from a PC. Let a few employees test the form before you roll it out.

How BrydgeOne supports this

In Incidents & reports, reports come in through the platform, the employee app or a public reporting point with a link or QR code, anonymously if preferred and without a login. In the app, staff report with just photos, by voice or in writing, and without signal the report is sent as soon as there is a connection again. For injury you select the type and point out the body part, and only people with the right to view injury data can see these details.

The handler sets the risk class with Kinney & Wiruth and, for a structural cause, switches on the CAPA review. Measures run through Actions, with an owner and a deadline, and the reporter receives status updates automatically. For leaks, spills and complaints from the neighbourhood you use Environmental reports. BrydgeOne helps you collect evidence for ISO 45001 and VCA, but it does not certify and does not guarantee that you comply.