Incident report template
This incident report template is designed to gather vital information, including the location, date, and individuals involved in an incident.
It serves as an effective tool for documenting incidents and enhancing safety measures.
Template tags
Incident report survey
Example questions
1. Date and Time of Incident
2. Location of Incident
3. Description of Incident
4. Names and Titles of Individuals Involved
5. Names and Titles of Witnesses
6. Type of Incident
e.g. injury, theft, property damage, etc.
7. Action taken immediately following the incident
first aid, evacuation, contacting authorities, etc
8. Was the incident reported to the proper authorities?
9. If yes, please provide the name and contact information of the responding agency
10. Details of any resulting damage or injury
11. Was the incident preventable?
12. If yes, please describe what steps could have been taken to prevent the incident
Incident Report Template Builder
Try out LimeSurvey's incident report template builder and create surveys that will help you gather information and document details about incidents that have occurred in your organization, improving your ability to analyze and prevent future incidents.
- Easy and simple to use
- Statistics
- Questionnaire templates
- GDPR compliance
- So much more…
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