Incident Investigation Report Form

A structured form for documenting workplace incidents, including incident details, timeline, contributing causes, witness information, evidence, and corrective actions.

Submission Notice

• What are you reporting?
• Submit anonymously
  Select this if you want to submit without your name. Anonymous submission may limit follow-up questions.
• I understand this form collects incident-related information for investigation, safety follow-up, and audit trail purposes.

Incident Details

• Date of incident
• Time of incident
• Location
• Brief summary of what happened
  Describe the event factually and concisely. Avoid opinions or blame.
• Was there an injury, illness, or damage?
• Immediate risk level

Timeline and Contributing Causes

• Timeline of events
• Potential contributing causes
• Explain the contributing causes

People Involved and Witnesses

• People involved
• Were there witnesses?
• Witness details

Evidence and Corrective Actions

• Evidence collected
• Upload evidence files
  Upload only relevant evidence. Avoid including unnecessary PII.
• Corrective actions
• Is follow-up required?
• Follow-up notes