Incident & Injury Report
An incident and injury report for field crews: sequence of events, people involved, treatment, immediate and root causes, witness statements and scene photos — filed from site the same day. Free to start.
Use this template with your own crew
Start a free trial, open it in the builder, and send it to a technician today. No card required.
Start free trial →30 days free · no card · cancel yourself any time. No seat minimum.
Would rather ask a person first? Email us — a human answers.
What happens when it's submitted
- Email the incident reportEmails a branded PDF
- Notify management immediatelyFlags for review · Notifies the office
- Flag high-potential incidentsFlags for review · Notifies the office
Incident & Injury Report, on a phone and as a PDF
Both panels are drawn from this template's actual fields, so they change when the form does. Sample values shown; branding and layout are yours to change in the PDF designer.
What's on the form
All of this is customizable to your process. Delete the fields you don't need, add the ones you do — and every lookup is powered by your customer list and your own data.
What happened
- People firstinstructions
- Site / customerRequiredcustomer lookup
- Site addressaccount field
- Date of incidentRequireddate
- Time of incidentRequiredtime
- Date reportedRequireddate
- Reported byRequiredemployee lookup
- Location stampGPS stamp
- Exact location on siteRequiredtextarea
Type & severity
- Incident typeRequireddropdown
- Actual severityRequireddropdown
- Potential severity had it gone differentlyRequireddropdown
- Describe what happened, in sequenceRequiredtextarea
People
- People involvedrepeating section
- Witnessesrepeating section
- Supervisor notifiedRequiredtoggle
- Emergency services attendedRequiredtoggle
- Client / site owner notifiedRequiredtoggle
Scene & equipment
- Scene photosRequiredphoto
- Equipment, tool, or vehicle involvedtext
- Equipment condition and last inspectiontextarea
- PPE in use at the timecheckbox
- PPE adequate for the taskRequireddropdown
- Person trained and authorized for the taskRequireddropdown
- A written procedure existed for this taskRequireddropdown
- Environmental conditionstextarea
Causes & corrective actions
- Conditions and decisions, not blameinstructions
- Immediate causeRequiredtextarea
- Contributing factorscheckbox
- Underlying causeRequiredtextarea
- Immediate actions taken to make it safeRequiredtextarea
- Corrective actionsrepeating section
- Work resumedRequireddropdown
- May be a recordable or reportable eventRequireddropdown
- Reported by signatureRequiredsignature
- Supervisor signatureRequiredsignature
Use this template with your own crew
Start a free trial, open it in the builder, and send it to a technician today. No card required.
Start free trial →30 days free · no card · cancel yourself any time. No seat minimum.
Would rather ask a person first? Email us — a human answers.