Workplace Incident Report

OSHA-aligned incident documentation. Use for injuries, near-misses, and property damage.

Report Number

Report Date

Project Name

Reported By

Supervisor

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Incident Details

Incident Date

Time

Location (specific area on site)

Weather Conditions

Incident Type

person

Injured / Affected Person

Name

Age

Job Title

Employer

Hire Date

Years in Trade

Description (what happened, in chronological order)

Root Cause Analysis (5-whys or similar)

Corrective Actions (what is being done to prevent recurrence)

group

Witnesses

Name	Statement

signature

Signatures

Reporter

Supervisor

Safety Manager

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Template only. Not a substitute for your company's safety program. Comply with OSHA requirements and consult an attorney for serious incidents.

About this form

OSHA requires employers to record work-related injuries and illnesses per 29 CFR 1904. Use this incident report to capture the facts immediately after an event — chronological description, root cause, corrective action, and witness statements — and then transfer recordable cases to your OSHA Form 300 log.

Fatalities and in-patient hospitalizations have mandatory reporting timelines: fatalities within 8 hours, hospitalizations / amputations / loss of an eye within 24 hours. Call OSHA at 1-800-321-OSHA.