Free Incident Report Form Template
Free Word incident report form for Queensland workplaces: record what happened, injuries, notifications, investigation and corrective actions, with tick boxes and date pickers.
RG
Written by Ryan Graham, health and safety professional (16 years on Queensland sites)
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About this template
This free incident report form template is an editable Microsoft Word form for recording a workplace incident, injury, illness or near miss in Queensland, from the first details through to the investigation and corrective actions. Fill it in on screen or print it for the site, then copy each report into your incident register.
A free Word form for reporting and investigating a workplace incident, injury, illness or near miss. It walks you through the details, the person involved, what happened, the injury, notifying the regulator and insurer, the investigation and the corrective actions, with sign-off at the end.
Use it with our Free Incident Register, Incident Management Policy & Procedure.
When should you fill in an incident report?
Complete an incident report as soon as practicable after any incident, injury, illness or near miss, while people still remember the details. Report near misses too: they show where the next injury could come from. Look after anyone who is hurt and make the area safe first.
Notifiable incidents in Queensland
Some incidents must also be reported to the regulator. Under the Work Health and Safety Act 2011 (Qld), a notifiable incident is (section 35):
- the death of a person
- a serious injury or illness: one needing immediate treatment as a hospital in-patient, or immediate treatment for an amputation, a serious head or eye injury, a serious burn, degloving or scalping, a spinal injury, the loss of a bodily function or serious lacerations, or medical treatment within 48 hours of exposure to a substance (section 36)
- a dangerous incident, even if no one was hurt: for example an uncontrolled spill, leak, fire or explosion, an electric shock, something falling from a height, or the collapse of a structure or an excavation (section 37)
The business must notify Workplace Health and Safety Queensland immediately after becoming aware of a notifiable incident, by the fastest possible means, and keep a record of it for at least 5 years (section 38). The site must not be disturbed until an inspector arrives or says otherwise, except to help an injured person, make the site safe or for other permitted reasons (section 39). The form has a section to record the notification and the reference number. Read more in our guide to notifiable incidents in Queensland.
How to write a good incident report
- Stick to the facts: what happened, where, when and who was involved, in plain words. Leave out blame and guesses.
- Talk to the people involved and the witnesses as soon as you can, and take photos before anything is moved, if it is safe to do so.
- Record the injury and the treatment, and whether the regulator and your workers’ compensation insurer need to be told.
- Find the root cause, not just the immediate cause, and agree corrective actions with a person responsible and a due date.
- Close it out: check the actions are done, sign it off and copy it into your incident register.
For a step-by-step guide with examples, read how to write an incident report. To record hazards before they cause an incident, use our free hazard report form.
What is included in our free incident report form?
- Incident details: number, date, time, location and incident type
- The person involved and their employment type
- What happened, the immediate actions taken and witnesses
- Injury or illness: body part, nature of injury, how it happened and the highest treatment
- Notification and claims: notifiable incident, regulator notified, reference number and insurer report
- Investigation: risk rating and root cause categories
- Corrective actions with owners and due dates
- Sign-off by the reporter, supervisor and manager
What you get
- An editable Microsoft Word form (3 pages), A4 portrait, to fill in on screen or print
- Tick boxes and date pickers that work in Word
- Business details typed once and filled in on every page, plus a space for your logo
- The same fields as our free Incident Register, so each report copies straight across
Review it and adjust it to suit your business, your sites and the way your team works, and talk it through with your workers.
Incident report form: frequently asked questions
What should an incident report include?
The date, time and place, the people involved and witnesses, what happened in factual terms, any injury or illness and the treatment given, whether it was a notifiable incident and who was told, the causes found in the investigation, and the corrective actions with who is responsible and by when.
What is a notifiable incident in Queensland?
A death, a serious injury or illness (such as one needing immediate treatment as a hospital in-patient, or for an amputation, serious burn or spinal injury), or a dangerous incident such as an uncontrolled fire, explosion or spill, an electric shock or a structure collapsing, even if no one was hurt (WHS Act sections 35 to 37).
How quickly must a notifiable incident be reported?
Immediately after the business becomes aware of it, by the fastest possible means, by phone or in writing. If you notify by phone, the regulator can ask for a written notice within 48 hours (section 38 of the WHS Act).
How long do I need to keep incident records?
Records of notifiable incidents must be kept for at least 5 years from the day the regulator was notified. Many businesses keep all their incident reports for the same period.
Should near misses be reported?
Yes. A near miss is not usually notifiable to the regulator unless it is a dangerous incident, but recording and investigating near misses helps you fix hazards before someone is hurt.
Is this incident report form free?
Yes. Enter your first name and email address and the Word file downloads straight away, with no card needed. You will also get our emails about new templates and WHS updates, and you can unsubscribe at any time.
This is general information, not legal advice. Check the current law or talk to Workplace Health and Safety Queensland for your situation.
Having trouble with your download? Contact us any time. Please read our Disclaimer before downloading.
How to use it
From download to site in three steps
Fill in the form and download
Enter your name and email. Your download buttons appear straight away and the links are emailed to you.
Make it yours
Open it in Microsoft Word or Excel. Add your logo, business details, site and job information, and adjust it to how the work is done.
Brief your crew
Talk it through with the workers doing the job, have them sign on, and keep it on site. Review it whenever the job or conditions change.
What format is it?
Microsoft Word. Edit it in Word, or free in Word for the web, and add your own logo and business details.
How do I get it?
Fill in your name and email on this page. Your download buttons appear as soon as you send the form, and the links are emailed to you. You can download it again from your account at any time.
Is it compliant with Queensland law?
It's written around Queensland's Work Health and Safety Act 2011 and Regulation 2011. Tailor it to your site, consult your workers and review it whenever conditions change; no template can guarantee compliance on its own.
What if it isn't right for my job?
Check the sample pages first. If the template has a fault or doesn't match its description, tell us and we'll fix it. Every template is a starting point that you tailor to your own work.
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