Incident Report Template

About this template

When to use it

An internal incident report. The header carries the [Incident report form 1] marker and three tick boxes — first / interim / final report — so the same sheet is filed several times as the case develops. The body runs I. what happened, II. damage, III. timeline, IV. cause analysis, V. prevention, VI. reporting log, each with a grey “how to complete” line beneath it.

Filling order

1. Enter the report number (sample ACC-2026-0001), date, department and author, and print the approval row (author, safety officer, team leader, head of department) blank. Tick the report stage or nobody can tell a first report from a final one.
2. I. Seven rows: time of occurrence (sample 09:47), location, incident type (injury, equipment, fire/explosion, spill, IT outage, other), first observer, escalation path, work in progress, and headcount split between direct and contractor staff.
3. II. Damage splits into people and property. The people table has fatalities, serious (3+ days off), minor (under 3 days) and near-miss rows, shipped as 0, 0 and 2. The property table asks for asset, damage, downtime, estimated loss and the basis of that estimate, with a total row.
4. III. Timeline has five columns and four stages already placed — noticed, escalated, contained, restored. The action and owner cells are empty; start there.
5. IV. Direct cause, indirect cause, management cause, and prior cases of the same type. Write the direct cause as one sentence, then ask “why” five times.
6. V. Prevention is pre-allocated as two immediate actions, two root-cause measures and one training or inspection item. Always fill owner and due date, and use the remarks table below for slipped items.
7. VI. Log the four notifications — internal first, internal final, authorities, victim and family — with time and method.

Four timestamps that must agree

The elapsed column in III is cumulative from 09:47: 09:57 noticed (10 min), 10:10 escalated (23 min), 10:55 contained (1 h 8 min), 13:01 restored (3 h 14 min). The footnote under the table says “restored in 4 hours”, which contradicts the last row — so update the footnote too when you enter real times. The 10:17 first report in section I must match the same entry in VI, and both must sit sensibly against the escalation row in III. Change one timestamp and you change three sections.

Why reports come back

• Leaving the sample casualty figures (0 · 0 · 2) in place. Write real numbers, including zeros, and do not skip the near-miss row.
• Giving an estimated loss with no basis of calculation.
• Writing “operator carelessness” as the direct cause and leaving the management cause blank — the prevention section then collapses into a single training line.
• Checking implementation once at the due date. The form asks for a second check three months later.