Fillable Form Employee Incident Report Form

What is an Employee Incident Report?

An Employee Incident Report is a document used by employees to report any incident in the workplace that may or may not have caused injuries to a person or damaged a company asset. An Employee Incident Report Form is used to capture injuries and accidents, near misses, property and equipment damage, health and safety issues, security breaches, and misconducts in the workplace.

The purpose of a Workplace Employee Incident Report is to record an incident, evaluate its possible cause, document any measures taken, and notify human resource management. An Employee Incident Report Template can be used in the investigation and analysis of an event. It includes the root cause and corrective actions to eliminate the risks involved and prevent similar future occurrences. Employee Workplace Incident Report Template can also be used as safety documents that indicate potential risks and uncontrolled hazards found in the workplace.

An incident report can be used by:

• An authority to create a report of an incident.
• A worker to report an incident he or she has witnessed.
• Any member of the organization to raise awareness about an incident that has occurred in the workplace.

Generally, an incident is defined as any event, condition, or situation which:

• Causes disruption or interference to an organization.
• Causes significant risks that could affect members within an organization.
• Impacts on the systems and operation of workplaces.
• Attracts negative media attention or a negative profile for the workplace.

Here are eight (8) items you should include in an employee incident report:

• Time and date of the incident.
• Where the incident occurred.
• A concise description of the incident.
• A description of the damages that resulted.
• Names and contact information of all involved parties and witnesses.
• Pictures of the area and any property damage.
• Video surveillance footage of the incident.
• Risk mitigation tactics used to prevent the type of incident.

All information must be clear and accurate. Provide specific details of what you are referring to and avoid any vague statements that may cause confusion. An incident report should be fact-based and objective. Avoid including emotional, opinionated, and biased statements. It should present both sides of the story and not favor one side over the other. If you have to incorporate statements from witnesses or patients, make sure you quote them accurately.

Ensure that the incident report answers all critical questions (what, where, when, why, and how). Not only should you keep track of the people who were hurt and what caused the accident, but you should also keep track of people who witnessed the occurrence and reported it, as well as those who will conduct an investigation. Consider what other important details will be required for any future research or investigation.

Supporting evidence should include photos, diagrams, illustrations, and video surveillance recordings. Take many photos of the injury, damage, and the surrounding environment. This supplements the facts stated and provides more clarity for the recipient to understand.

You must complete an Employee Incident Report as soon as possible after the occurrence of an incident. There are various types of incidents that you can choose to report while you’re in the workplace. Here are four (4) main incident reports:

• Near Miss Reports – Near misses are incidents in which no one was hurt, but someone could have been if the time or action had been different. Because of this, it’s critical for professionals to record such incidents so that corrective action may be taken so that no one else is exposed to such a risk in the future. This will help keep all workers safe while on site.
• Injury and Lost Time Incident Report – This type of incident report is used to keep track of any injuries that result in lost time. When certain safeguards are not taken or other circumstances beyond our control come into play, injuries can occur on-site. These incidents must be reported quickly in order to implement appropriate corrective steps and reduce the likelihood of a repeat occurrence.
• Exposure Incident Report – While on the job, you may be exposed to hazardous chemicals or substances like asbestos, carbon monoxide, and others. To help keep people safe, safety experts should report such instances as soon as possible.
• Sentinel Event Report – Extreme incidents that result in death or serious permanent harm are known as sentinels. These events are unexpected and can include occurrences such as natural disasters, illness outbreaks, slips, trips and falls, struck bys, and others. These occurrences must be documented in order to develop your safety program and take the necessary procedures to protect workers in the event that similar unforeseeable incidents occur again.

Upon completion, those who are involved in the incident (such as victim, witnesses, manager, and reporter) should sign off to attest and confirm all of the facts provided in the incident report. This verifies that the incident report is accurate and uncontested.

How to fill out an Employee Incident Report?

Using PDFRun, you can electronically fill out and download a PDF copy of the ’s an Employee Incident Report PDF in minutes. Fill it out by following the instructions below.

Date

Enter the date you’re filling out the form.

Employee

Name

Enter your full name.

Title/Position

Enter your title or position in the company.

Manager

Name

Enter your manager’s name.

Title/Position

Enter his or her title or position in the company.

Incident

Date

Enter the date of the incident.

Time

Enter the time of the incident.

Location

Enter the location of the incident.

Description of the Incident

Enter a concise description of the incident.

Employee Explanation

Enter your explanation regarding the incident.

Witnesses

Enter the names of witnesses to the incident.

Action To Be Taken

This is to be filled out by your supervisor.

Mark the appropriate box for which action should be taken with regard to the incident. Your supervisor may select:

• Verbal Warning
• Written Warning
• Probation
• Suspension
• Dismissal
• Other

Explain

This is to be filled out by your supervisor.

Enter the explanation for the chosen action on the preceding line. If “other” was chosen, enter what other actions must be taken.

Employee

Affix your signature.

Date

Enter the date you signed the form.

Manager

Affix your manager’s signature.

Date

Enter the date your manager signed the form.

Frequently Asked Questions About an Employee Incident Report

How do I write an employee incident report?

An employee incident report is a form that is used to record details of an unexpected or undesirable event that occurs in the workplace. This type of report is usually completed by a supervisor or manager, and it is then sent to the human resources department.

The purpose of an employee incident report is to document what happened, identify any potential witnesses, and determine if any disciplinary action is necessary. In addition, the report may be requested by legal counsel during an investigation or lawsuit.

To write an effective employee incident report, you should first gather as much information about the event as possible. This may include interviewing witnesses or other employees who were involved. Once you have all of the details, you can begin writing your report.

You should begin your report by describing exactly what happened and when it occurred. Be sure to focus on facts rather than opinions or speculation. Next, describe any injuries that resulted from the incident, as well as any property damage that was caused. Then, identify any potential witnesses and interview them if necessary. Finally, make a recommendation for any disciplinary action that may need to be taken, and provide your contact information in case further details are needed.

If you are completing an employee incident report for yourself or another member of your team, it is important to be as thorough and accurate as possible. This will help ensure that you are in compliance with any company policies or legal requirements, and it can also help prevent similar incidents from occurring in the future. Additionally, keeping a detailed report may be useful if there is an investigation related to the incident or if you need to defend your actions later on. And if you are completing this type of report for another employee or supervisor, it is important to remain objective and factual while gathering information so that you provide an accurate account of what happened. Overall, taking the time to write an effective employee incident report can help protect the safety and well-being of everyone in your organization.

If you have been assigned the task of writing an employee incident report, there are a few things you should keep in mind:

• It is important to be as objective and factual as possible when describing what happened. This means that you should avoid using opinionated language or making assumptions about what occurred.
• You should focus on the facts of the incident, rather than your personal opinion or speculation.
• You should make sure to include all relevant information, such as the names of any witnesses or other employees who were involved.

By following these tips, you can ensure that your report is accurate and helpful.

What are the requirements for writing an incident report?

When writing an incident report, you should include certain important pieces of information, such as the names of any witnesses to the incident, a description of what happened, and when and where it occurred. You should also include your personal contact information in case anyone has any questions about the incident. If you witnessed the incident yourself, be sure to include your account of what happened in your report.

If you have any photographs or other evidence related to the incident, be sure to include them with your report. Once you have gathered all of this information, you can begin writing your report. Start by including the date and time of the incident, as well as the location. Then, give a brief description of what happened. Include any relevant details that will help explain the incident, such as whether anyone was injured or if there were any witnesses.

Be sure to sign and date your report before submitting it. If you have any additional questions or concerns about how to write an effective incident report, consider consulting a professional writing service for more guidance.

Writing an effective incident report can be challenging, but with the right approach and attention to detail, you can create a clear and concise report that effectively captures all of the necessary information.

Your incident report should be:

• Accurate — It must be based on facts that can be verified.
• Complete — Include all relevant information about the incident, such as names, dates, times, locations, and a description of what happened.
• Objective — Stick to the facts and avoid making judgments about who was at fault or whether the incident could have been prevented.
• Clear and concise — Use simple language to describe what happened and avoid using jargon.

What are office incident examples?

Examples of office incidents and emergencies

There are many different types of office incidents and emergencies that can occur. Here are some examples:

• Fire — A fire in the office can be caused by a number of things, such as electrical equipment, smoking materials, or even a faulty appliance. If a fire does break out, it is important to evacuate the building immediately and call the fire department.
• Flood — A flood in the office can be caused by severe weather conditions, a broken pipe, or even a clogged toilet. If there is flooding in the office, it is important to turn off all electrical equipment and move any valuable items to higher ground.
• Gas leak — A gas leak in the office can be dangerous, and should be treated as an emergency. If you suspect that there may be a gas leak, it is important to evacuate the building and call the local utility company right away.
• Chemical spill — A chemical spill in the office can cause serious health problems if not dealt with properly. If you encounter a chemical spill in the office, it is important to put on protective equipment such as gloves and a mask before attempting to clean up or contain the spill.
• Power outage — A power outage in the office can happen for a number of reasons, such as bad weather, a downed power line outside your building, or even a systems failure within your building's electrical infrastructure. In the event of a power outage, it is important to have a plan in place for how to safely evacuate the building.
• Earthquake — An earthquake can cause serious damage to your office, and even pose a danger to your safety. If an earthquake occurs, it is important to drop to the ground and take cover under a sturdy piece of furniture. Stay away from windows, and do not use elevators until you are sure it is safe to do so.

As you can see, there are many different types of office incidents and emergencies that can occur. It is important to be prepared for any emergency by having a plan in place for how to respond quickly and safely. By following these guidelines, you can help protect yourself, your coworkers, and your office from the dangers of an emergency situation.?

What are 3 types of incidents?

There are three types of incidents in the office that we must prepare for:

• Major incidents — These are one-time events that cause significant disruption to the workplace. They can include natural disasters, fires, and power outages.
• Repetitive incidents — These are smaller-scale events that happen regularly. They might not cause as much damage or disruption, but over time they can add up. Examples of repetitive incidents include water leaks, broken office equipment, and minor electrical issues.
• Complex incidents — These are those that are difficult to predict or prevent, and may require a more coordinated response from the office staff. Examples of complex incidents include workplace violence or security breaches.

Whether dealing with major, repetitive, or complex incidents, it is important for office staff to have clear protocols in place for dealing with these situations. This might include having a designated team of staff who work together to respond to incidents or creating a plan for how to communicate and coordinate with external resources in the event of an emergency. Whatever your office's approach may be, it is important to have systems in place that ensure the safety and well-being of all employees during these challenging events.

What are the 4 types of incident reports?

Incident reports are written to document incidents that have occurred. There are four main types of incident reports: first-hand accounts, police reports, witness statements, and insurance claims. Each type of report has its own purpose and format.

• First-hand accounts — These are written by the person who experienced the incident. They provide a detailed, personal account of what happened.
• Police reports — These are written by law enforcement officers who have investigated the incident. They include information about the evidence collected and the officers' observations.
• Witness statements —These are given by people who saw the incident occur. They provide a description of what they saw and heard.
• Insurance claims — These are filed when an incident results in damage or loss. They document the damages incurred and may include estimates for repair or replacement costs.

All four types of incident reports serve an important purpose in documenting incidents and helping to prevent future similar occurrences. They can also be used as evidence if legal action is taken as a result of the incident. Whether you are writing one of these reports or need information about one, it is important to understand its purpose, format, and use.

If you have any questions about incident reports or need assistance with writing one, please contact your local law enforcement agency or insurance company for guidance.

What are the three C’s of an incident report?

The three C’s of an incident report are Cause, Consequence, and Corrective Action.

• Cause — This refers to the factors that led up to an incident or accident that caused injury or property damage.
• Consequence — This is the effect or outcome of an incident or accident, including any physical injuries and damages to property.
• Corrective Action — This involves identifying the steps that need to be taken in order to prevent similar incidents from occurring in the future.

Understanding these three key aspects of incident reporting is essential for ensuring a safe working environment and minimizing the chances of accidents and injuries occurring in the workplace.

There are many different factors that can contribute to incidents in the workplace, such as unsafe conditions, inadequate training, equipment failure, human error, lack of supervision, and more. It’s important to identify the root cause of an incident in order to develop effective corrective actions and prevent future accidents from happening. In some cases, multiple factors may have contributed to an incident, so it’s important to thoroughly investigate all aspects of the case in order to identify all possible causes.

Once the cause or causes of an incident have been identified, it’s important to determine the consequences that resulted from the accident or injury. This includes assessing any physical injuries that were sustained by employees or other individuals as well as damage to property. It’s also important to consider the financial impact of an incident, such as lost work time, medical expenses, and workers’ compensation claims.

Once the cause and consequences of an incident have been identified, it’s important to develop appropriate corrective actions. These actions will depend on the nature of the incident, as well as any safety measures that were already in place at your workplace. Possible steps that might be taken include additional training for employees, modifying equipment or processes to reduce risks, conducting more frequent inspections, and implementing stricter safety standards. It can also be helpful to establish a system to track incidents and their causes over time so you can identify patterns and trends in order to make necessary improvements to your safety program.

Overall, understanding the three key components of an effective incident report is critical for ensuring workplace safety and mitigating the risk of future accidents occurring in your organization. By identifying the cause of an incident and taking appropriate corrective actions, you can help prevent similar incidents from occurring in the future.

What should be included in an incident report?

There are a few key pieces of information that should be included in an incident report. These include:

• The date, time, and location of the incident
• A description of what happened
• The names and contact information of any witnesses
• The name and badge number of the responding officer(s)
• Any evidence or property that was collected at the scene
• A statement from the victim or complainant detailing what happened

If there are any surveillance images or video footage of the incident, this should also be included in the report. All of this information will help to paint a picture of what happened and will be crucial in conducting a thorough investigation.

In addition to this information, it is also important to include any other relevant details that may be helpful when reviewing the incident. This could include the suspect's physical appearance or demeanor, descriptions of suspicious vehicles or individuals in the area prior to or after the incident, and any other potential leads that may help identify a perpetrator.

Overall, the key goal of an incident report is to provide a clear and detailed account of what happened so that any necessary follow-up actions can be taken. It is essential that all relevant information is included so that investigators are able to fully understand what occurred and how they should proceed. Without an accurate record of events, it can be difficult to bring those responsible for these incidents to justice.

Why do you need an incident report?

One of the most important reasons for writing an incident report is to document and record information about an accident or other occurrence that takes place within your organization. Such reports are vital for ensuring that appropriate action can be taken in response to a particular event, and for preventing similar events from occurring in the future. In addition, keeping a detailed and accurate incident report is essential for protecting your organization from potential legal issues or claims as a result of any accidents or incidents that occur on your premises.

Another key reason why you should create and maintain incident reports is to provide documentation of actions taken after a breach of security in order to help prevent further incidents from occurring in the future. For example, if there is an attempted theft on your premises, having a well-written incident report can help you to implement new security measures to deter future attempts. Additionally, if an employee is injured while on the job, an incident report can provide crucial information that can be used to improve workplace safety.

Lastly, incident reports can also serve as a valuable training tool for your staff. By reviewing past reports, your employees can learn about potential hazards and how to best avoid them in the future. In sum, creating and maintaining accurate and up-to-date incident reports is essential for any organization in order to protect its people, property, and reputation.

What are the five elements of a good incident report?

The five elements of a good incident report are:

1. The time, date, and location of the incident — This is important so that authorities can determine if the incident is connected to any other incidents and, if so, create a timeline of events.
2. A description of the incident — This should be as clear and concise as possible, without leaving out any important details.
3. The names, ages, and contact information of any witnesses — Witnesses can provide valuable information about what happened and who was involved.
4. The name and contact information of the individual or organization filing the report — This is important so that authorities can get in touch with the person or organization if they have any questions.
5. Any other relevant information — This could include photos or videos of the incident, descriptions or timelines of previous incidents, and any other details that may help to understand what happened and who was involved.

Overall, a good incident report should be thorough, accurate, and objective in order to help authorities effectively investigate and resolve the situation.

When should an incident report be completed?

An incident report should be completed as soon as possible after an incident occurs. This will ensure that all relevant information is captured and that any necessary follow-up can be conducted in a timely manner. It is important to have a clear, detailed plan for how to complete an incident report as well as policies and procedures in place that support the process. This will help ensure accurate and consistent reporting across your organization.

There are a few key factors that should be considered when determining when an incident report should be completed. These include:

• The severity of the incident — If the event is serious or potentially dangerous, you may need to contact law enforcement or other emergency response teams immediately in order to keep those affected safe. Otherwise, it is typically best to complete a report before taking any further action or making any decisions about what steps should be taken next.
• The availability of witnesses — In some cases, it may not be possible to collect all the information you need from witnesses immediately after an incident. For example, if an accident occurred on a remote worksite, witnesses may not be readily available until they are transported to the site. In these situations, it may be best to complete the report and then follow up with witnesses as soon as possible in order to gather additional details.
• The availability of evidence — In some cases, it may not be possible to get all of your evidence before taking any action or making decisions about what steps should be taken next. For example, if there has been damage to property or equipment, you will typically want to document and assess this issue before taking any further steps. However, in some instances, it may not be safe to wait to collect evidence and it may be best to complete the report and then follow up with any needed steps.
• The importance of timeliness — In some situations, you will need to take immediate action or make important decisions about what steps should be taken next in order to prevent additional incidents from occurring. For example, if a potential safety hazard exists at your organization that must be addressed quickly in order to prevent serious injury, it is essential that you are able to act quickly and provide the information required for these temporary or permanent changes as soon as possible. In these situations, you may want to complete the report immediately after an incident occurs and gather additional details on the go while taking action or making decisions based on this initial information.

Determining when to complete an incident report can be a complex process. However, by considering the factors above and developing clear procedures for how to complete incident reports, you can ensure that all necessary information is captured quickly and accurately. This will support your organization in addressing any issues or concerns related to the incident as well as ensuring the future safety of those affected by the event.

What are the steps of the incident response process?

The incident response process is a set of defined steps that are taken in response to an office incident. The steps are designed to help resolve the incident as quickly and efficiently as possible. The steps of the incident response process are:

1. Initial notification — This is when the incident is first reported.
2. Preliminary assessment — This is when initial information about the incident is gathered and a preliminary assessment is made.
3. Activation of response team — This is when the appropriate response team is notified and activated.
4. Investigation and containment — This is when the incident is investigated and containment efforts are put in place.
5. Eradication and recovery — This is when the underlying cause of the incident is removed and recovery efforts are put in place.
6. Post-incident activity — This is when monitoring and further response efforts are put in place after the incident is resolved.

While each organization will have its own unique incident response process, these steps provide a good framework for understanding how to respond effectively to an office incident. By following this process consistently, organizations can better protect their data and minimize the impact of any incidents that do occur.

Related Articles:

• A Guide to Incident Reporting in the Workplace
• Incident Reporting is Critical to Your Workplace Safety Program
• How to Write a Good Accident or Incident Report