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Incident report template
An incident report is the written record of an unplanned event at work that hurt someone, made someone ill, damaged equipment or nearly did. It is filled in the same shift by the person involved, a witness or the supervisor, and it holds the facts while they are fresh: what happened, where and when, who was there, the injury or damage, the treatment and what was done straight away. Page 1 of this template is for whoever starts the report: the type of incident, the people involved, what happened in order, the injury, illness or damage, the immediate actions and the witnesses. Page 2 is for the supervisor or safety lead within 24 hours: treatment and work status, a screen for US employers that asks the 29 CFR 1904 recording questions, a first look at the cause, actions ranked by the hierarchy of controls, and a confidential strip for the employee details. Between the two pages there is a field for every item on OSHA Form 301, and page 4 maps each one. A serious case goes on to a full incident investigation. The Excel version is an incident log for 100 reports that flags cases that look recordable, the OSHA reporting deadline, the 7-day date for the 300 log, overdue actions and days open.
Free to use: print it, copy it and edit it for your team. Enter your name and work email once to download.
Header fields for date, time, shift and area, tick boxes for the type of incident, a people involved table, a box for what happened, fields for the injury and the object that did the harm, a sketch area, immediate actions and witnesses.What happened, in orderPeople and witnessesInjury, illness or damageTreatment and work statusUS recordkeeping screenEvery OSHA 301 itemActions by control typeExcel incident log
When to use it
When to fill in an incident report
- After any injury or illness at work, including a cut that only needed a bandage, the same shift.
- After damage to equipment, product or the building, a spill or release, a fire, or a forklift or vehicle collision, even when nobody was hurt.
- After a near miss, if your site logs them on the same form; the short near miss report form works too.
- When a US employer needs the facts for the OSHA 300 log and a Form 301 or equivalent, which must be done within 7 calendar days of learning of a recordable case.
How to fill it in
- 1
Make it safe first
Care for the injured person, make the area safe and stop the job if needed. The report comes after, the same shift.
- 2
Write what happened, in order
What the person was doing just before, with which tools or material, then what happened step by step. Write what you saw and heard, not who is to blame.
- 3
Record the harm and the immediate actions
The body part and how it was hurt, the object or substance that did the harm, any damage, the first aid given, and what was done to the area: cleaned up, locked out, photographed.
- 4
Take witness statements
Talk to each witness on their own, soon, and attach what they say in their own words.
- 5
Supervisor: treatment, work status and the screen
Within 24 hours, add the treatment, any days away or restricted, and answer the recordkeeping questions. If the case looks recordable, enter it on the 300 log within 7 calendar days.
- 6
Act, or open an investigation
Set actions with an owner and a due date, strongest control first. If the outcome or the worst credible outcome was serious, open a full incident investigation.
OSHA Form 301
Which OSHA 301 item each field covers
OSHA Form 301, the Injury and Illness Incident Report, has 18 numbered items. US employers complete it, or an equivalent form, for every recordable case (29 CFR 1904.29(b)(2)). This template has a field for each item, paraphrased here, not copied.
| 301 item | What it asks for | Where it is on this template |
|---|---|---|
| 1 to 5 | The employee: full name, address, date of birth, date hired, sex | Page 2, confidential strip |
| 6 and 7 | The physician or health care professional, and where treatment was given if away from the worksite | Page 2, treatment and work status |
| 8 and 9 | Treated in an emergency room, and hospitalized overnight as an in-patient | Page 2, treatment and work status |
| 10 | The case number from the 300 log | Page 2, recordkeeping screen |
| 11 to 13 | Date of the injury or illness, the time the employee began work, the time of the event | Page 1 header and page 2 |
| 14 and 15 | What the employee was doing just before, and how the injury happened | Page 1, what happened |
| 16 and 17 | The injury or illness and the body part, and the object or substance that harmed the employee | Page 1, injury, illness or damage |
| 18 | The date of death, if the employee died | Page 2, treatment and work status |
1 to 5
- What it asks for
- The employee: full name, address, date of birth, date hired, sex
- Where it is on this template
- Page 2, confidential strip
6 and 7
- What it asks for
- The physician or health care professional, and where treatment was given if away from the worksite
- Where it is on this template
- Page 2, treatment and work status
8 and 9
- What it asks for
- Treated in an emergency room, and hospitalized overnight as an in-patient
- Where it is on this template
- Page 2, treatment and work status
10
- What it asks for
- The case number from the 300 log
- Where it is on this template
- Page 2, recordkeeping screen
11 to 13
- What it asks for
- Date of the injury or illness, the time the employee began work, the time of the event
- Where it is on this template
- Page 1 header and page 2
14 and 15
- What it asks for
- What the employee was doing just before, and how the injury happened
- Where it is on this template
- Page 1, what happened
16 and 17
- What it asks for
- The injury or illness and the body part, and the object or substance that harmed the employee
- Where it is on this template
- Page 1, injury, illness or damage
18
- What it asks for
- The date of death, if the employee died
- Where it is on this template
- Page 2, treatment and work status
A filled-in example
Illustrative, not a benchmarkAn example (illustrative): a press operator slips on hydraulic oil at a made-up stamping plant. The PDF page 3 and the Excel Example sheet hold the same report.
- What happened: at 10:40 on the day shift, operator A was carrying a box of brackets from press 4 to the coil cart, stepped in a patch of hydraulic oil, slipped and fell onto the left hand. The line lead saw it. The oil came from a leaking hose fitting on the press hydraulic unit.
- Immediate actions: a cold pack at the first aid station, a drive to the clinic, the oil soaked up and the area coned off, press 4 locked out and the fitting tagged, six photos.
- Treatment: an X-ray showed no fracture; a wrist splint with rigid stays, and no lifting with the left hand for 4 days, so A moved to the packing bench from the next day.
- Screen: work-related, a new case, medical treatment beyond first aid (the rigid splint) and restricted work beyond the day of injury, so it looks recordable and a DART case. The X-ray alone would not count, it is a diagnostic procedure. No report to OSHA: nobody died, was admitted, lost a limb or an eye.
- Cause and actions: an unsafe condition, oil on the walkway from a leak that had been tagged six days earlier and was still open. The fitting was replaced, a drip tray fitted, a leak check added to the press start-up check, and open safety tags now go through the daily tier 1 meeting.
The supervisor learned it was recordable on the day, 15 September, so the 300 log entry was due by 22 September; it went in as case 2026-07 on 17 September. In the month's Excel log this is one of 6 incidents: 2 look recordable, 1 is a DART case, 2 were first aid only, and all 6 closed in 7.3 days on average (44 days over 6 reports).
Common mistakes
Waiting until the end of the week
Memories fade and the scene gets cleaned up. Start the report the same shift, and take witness statements the same day.
Writing the cause before the facts
"Operator was careless" is a conclusion, not a fact. Write what happened in order, and leave the why to page 2 and the investigation.
Calling it first aid when it was not
First aid is a closed list in 29 CFR 1904.7(b)(5)(ii). Sutures, rigid splints and prescription-strength medicine are medical treatment, and the case is recordable even when the worker is back on the line.
Making people afraid to report
Discipline or prizes tied to injury counts hide incidents. A reporting procedure that would deter a reasonable employee is not reasonable under 1904.35(b)(1)(i), and retaliation is prohibited.
Filing it with no action
A report without an owner and a due date changes nothing. Fix the condition, check it on the floor, and tell the person who reported it what changed.
Download the template
Free to use: print it, copy it and edit it for your team. Enter your name and work email once to download.
Run this template in LeanSuite
In LeanSuite anyone scans the QR code on a machine or area to report a hazard, near miss or first aid incident with a photo, the tag is routed to an owner and tracked until it is fixed, and a recurring problem can be escalated into a formal incident investigation in one click.
See it in a 45-minute demoIn the lean glossary
Guides
- Incident investigation report template: the next step for a serious case
- Near miss report form: the short form for close calls
- Root cause analysis guide: from the report to the cause
- OSHA 300 log workbook: where a recordable case goes next
- TRIR and DART rate tracker
- Just culture: why people report and why they stop
- Unsafe acts and unsafe conditions: how to tell them apart
- Why Most Manufacturing Hazards Go Unreported
- 7 Preventable Shop Floor Incidents Most Plants Miss
FAQ
Incident report template: common questions
The date, time, shift and place; the type of incident; the people involved and the witnesses; what the person was doing and what happened, in order; the injury, illness or damage and what caused it; the first aid and treatment; any days away or restricted work; the immediate actions; a first look at the cause; and actions with owners and due dates.
Write it the same shift, in plain words and in the order things happened. Start with the task the person was doing, then what went wrong, then the injury or damage. Stick to what you saw and heard, name the equipment and the material, and leave out guesses and blame. The worked example on this page shows the level of detail.
Your company sets the deadline for its own report, and the same shift is a good rule. For US employers, a recordable case must be entered on the OSHA 300 log and a Form 301 or equivalent within 7 calendar days of learning of it (29 CFR 1904.29(b)(3)), and a work-related death must be reported to OSHA within 8 hours, an in-patient hospitalization, amputation or loss of an eye within 24 hours (1904.39).
The incident report records the facts straight away: what happened, the harm and the immediate actions. The investigation comes after a serious case and finds the causes at every level, with a timeline, evidence and actions checked on the floor. Most first aid cases need only the report and a fix; a serious injury or a near miss that could have been serious needs both.
Incident is the wider word: any unplanned event that caused, or could have caused, injury, illness or damage. An accident is an incident where harm was done. A near miss is an incident where nothing was harmed this time. One form can record all three, with the type ticked at the top.
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- Nemawashi template (stakeholder plan)Plan the one-to-one conversations before a decision: who to talk to in what order, their concerns, what changed and where they stand.
- Breakdown analysis reportOne equipment breakdown from the stop to the 90-day check, plus a breakdown log with repeat flags, MTBF and MTTR by asset and a Pareto of causes.
- Heijunka box planner (production leveling)Weekly demand turned into containers a day, takt, pitch and slots, a leveled sequence of products and the heijunka box, with a check that the changeovers fit.
- 4M change management sheet (change point)A shift log of every change to Man, Machine, Material, Method or Design, the extra checks after it and when normal checks resume, with a change point board.
- Future state value stream map worksheetThe eight future-state questions worked through in order: takt, pitch, flow, supermarkets, the pacemaker and the mix, with an EPEI check and current against future lead time.
- Value stream plan (VSM action plan)The future-state map cut into loops, each with an objective and a measurable goal, and its kaizen bursts turned into owned, dated projects on a 12-month timeline.
- Kaizen project plan (Gantt chart)One improvement project as a Gantt chart: tasks by phase with owners, predecessors and working days, a 16-week grid, milestones and a status from planned against actual % done.
- Histogram templateReadings, bins set by the square root rule, a tally and counts, the spec limits drawn and the share out of spec, with the common shapes explained.
- Scatter diagram templateUp to 50 pairs with a group code, r and R², the least squares line, the quadrant count and r for each group.
- Gauge calibration logA gauge register with next due dates and status, a calibration record with as-found and as-left readings, and the steps when a gauge fails.
- Escalation matrix templateWho is called for each type of issue and after how long, with severity rules, contacts and an escalation log.
- Visual management audit checklist29 checks of whether anyone can tell normal from abnormal at a glance, scored by group, with a trend and actions.
- Quality alert formA quality alert to post at the line, a sign-off sheet for every shift, and a log of open, expired and closed alerts.
- TQM self-assessment templateThe eight TQM principles in 24 statements you can check on the floor, scored 0 to 4 by several people, with the spread, the top 3 gaps and an action plan.
- Employee recognition program templateDesign a recognition program on one page, then run it: points per action, prizes, budget, a points ledger, a monthly leaderboard and a fairness check by team and shift.
- Lean transformation roadmapA plant-wide lean program on one sheet: six phases with exit criteria, six workstreams by quarter over 24 months, the model line, metrics with baseline and target, cadence and risks.
- Obeya room plannerPlan the walls, owners, cadence, agenda and rules of an obeya, then run the weekly review of KPIs, problems, actions and milestones.
- Paper forms inventory (paperless manufacturing worksheet)Every paper form, checklist and log in one list: hours a month, who acts on it, how long the paper waits, and which forms to move first.
- Continuous improvement software evaluation scorecardCompare CI software vendors: a must-have gate, eight weighted criteria scored 1 to 5, points out of 100 and a rank, with a demo script and reference questions.
- Lean principles assessment templateThe five lean principles as 25 things you can see on one value stream, answered yes, partly or no on a walk, with a score per principle, the next step and a trend over walks.
- Employee engagement survey templateA short anonymous pulse survey for shop floor staff: 14 statements in six drivers, two open questions, results by driver and team, and the actions.
- Hansei reflection sheet (lessons learned)A written look back at one finished project, event or launch: goals against results in numbers, causes rather than blame, lessons to keep or change, and where else they apply.
- Daily kaizen routine boardA team's 10 to 15 minute daily routine at the board: one problem from each person, small fixes with one owner, counted every week.
- Quality circle meeting recordA circle's charter, a one-page record for each meeting and a problem register that follows every problem from selected to closed or escalated.
- Weekly maintenance schedule templateNext week's maintenance jobs, scheduled only when ready, loaded against each craft's hours by day, with schedule compliance and break-ins at week end.
- Operational excellence assessment templateThe ten principles of operational excellence as 30 behaviors and practices you can see, scored 1 to 5 by several people, with the spread, the three lowest principles and an action plan.
- Scrum meeting agenda templateTimed agendas for the five scrum meetings, a sprint planning sheet, a retrospective sheet, and an Excel sprint backlog with a burndown.
- Toyota Production System (TPS) house templateThe TPS house for one plant or value stream: roof, two pillars and foundation, with what you do today, the evidence, a status and the next step for each element.
- EPEI and batch size calculatorHow often each part can come round on a shared machine (EPEI) and how big each batch must be, from demand, cycle times and changeovers, now and after SMED.
- People, process, technology (PPT) assessmentCheck one change before go-live: 18 people, process and technology statements scored 1 to 4 by the people who will use it, the lowest element and the actions.
- Process capacity sheet templateEach machine in a part's routing with manual, auto and tool change time, its capacity per shift, and the step that limits the cell against demand.
- Jidoka worksheet (stop at abnormality)For one line or cell, every abnormality that should stop the work: how it is detected, how the work stops, who is called, the immediate fix and the root cause step, plus a log of real stops.
- Team charter templateA one-page charter for a standing team: purpose, scope, roles, the KPIs it owns, which decisions it makes itself, norms and cadence.
- Chaku-chaku line plannerPlan a load-load cell: time each machine, load and walk, check that every machine is ready when the operator comes back, compare the cell cycle with takt and size the crew.
- Standard operating procedure (SOP) templateA full SOP in the hierarchical step format, from purpose and scope to the steps, records, revision history and approvals, with review checks and an SOP register.
- Process improvement method selectorEight questions about one problem, an example rule that suggests a method and a matrix of nine methods: when each fits, the usual team and time, and the template to start with.
- X-bar and R control chart template25 subgroups with means and ranges, control limits from A2, D3 and D4, signal flags, both charts and a reaction log.
- Gage R&R study sheet10 parts, 2 or 3 appraisers, 2 or 3 trials: EV, AV, GRR, PV, %GRR and ndc by the average and range method.
- Root cause analysis templateOne report from problem statement to proof: containment, evidence, analysis, verified causes, actions and the effectiveness check.
- Quality control pillar 90-day model area planThirteen weeks from the QA matrix to the QM matrix on one model area, a KPI board, the day-90 gate and expansion waves.
- Autonomous maintenance 90-day model area planAM steps 0 to 3 on one model machine in 13 weeks, a KPI board, the day-90 gate and expansion waves for months 4 to 12.
- Professional maintenance (PM) 90-day model area planThirteen weeks from breakdown analysis to a running PM calendar on one model machine, a KPI board, the day-90 gate and expansion waves.
- Environment and energy pillar 90-day model area planThirteen weeks from waste and energy maps to area standards on one model area, a KPI board, the day-90 gate and expansion waves.
- Focused improvement 90-day model area planThirteen weeks from the loss Pareto to standardized fixes on one model line, a KPI board, the day-90 gate and expansion waves.
- Logistics and customer service pillar 90-day model area planThirteen weeks from the current-state map to pull on one model value stream, a KPI board, the day-90 gate and expansion waves.
- People development pillar 90-day model area planThirteen weeks from the skills matrix to trained cover on critical tasks in one model area, a KPI board, the day-90 gate and expansion waves.
- Early equipment management 90-day model area planThirteen weeks from lessons on current machines to a tracked start-up on one model equipment project, a KPI board, the day-90 gate and expansion waves.
- Cost deployment pillar 90-day model area planThirteen weeks from the loss map to costed, ranked projects in one model area, a KPI board, the day-90 gate and expansion waves.
- Moving from Excel to one system checklistA 34-point checklist and a file inventory for moving trackers from spreadsheets to one system: keep, move, connect or retire, clean, pilot, run both, retire.
- Prioritization matrix templateScore up to 20 improvement ideas on weighted criteria, rank them, test the ranking with equal weights and place each one on an effort and benefit grid.
- Cost per unit worksheet (manufacturing cost per good unit)One product's cost per good unit by materials, labor, machine and overhead, the gap to target, and which cost lever is worth most a year.
- Digital manufacturing readiness assessmentScore 24 statements on process, technology and people from 0 to 4, check the balance between them and rank the gaps by what matters in your plant.
- Manufacturing KPI dashboard templateWeekly plant numbers in, 14 KPIs out: OEE and its parts, first pass yield, scrap, on-time delivery, recordable rate, cost and absence, each against a target.
- RCM worksheet (failure mode and task selection)Failure modes classed as hidden, safety, operational or non-operational, then a task chosen for each: condition-based, discard, failure-finding, redesign or run to failure.
- Error-proofing verification log (daily master-sample check)Each poka-yoke device proved every day or week with a known-bad sample, with missed checks counted and the hours and parts at risk worked out when one fails.
- Downtime reason codes template26 starter codes mapped to the six big losses, a log with drop-downs, a Pareto by code and by loss, and a code card for the line.
- Defect catalogue template with boundary samplesEvery defect with a definition, a class and the reason for it, measured accept and reject limits by zone, boundary samples, a defect log with DPU and Pareto, and an inspector agreement check.
- I-MR chart template (individuals and moving range)Up to 100 single readings with moving ranges, limits from a baseline, five run-rule flags, both charts, a second phase and a reaction log.
- Kaizen event preparation checklistEverything that has to be ready before a kaizen event and done after it: 44 items with owners and due dates from 6 weeks before day 1 to 30 days after, five go or no-go gates and a day-by-day agenda.
- Attribute control chart template (p, np, c and u charts)p, np, c and u charts in one workbook: a chart selector, a sample size check, limits for each subgroup, signal flags and four worked examples.
- Critical spare parts list and stocking levelsAssets ranked by consequence, each part classed and given a stocking policy, and min and max worked out from usage and lead time, with the downtime each stock-out would cost.
- Tier 2 meeting agenda and escalation sheetA 15-minute tier 2 agenda in ten timed blocks, fixed roles and rules, escalation triggers with time limits, and a log that ages every escalation and sends the answer back down.
- Mock recall template: traceability exercise worksheetTrace a finished lot back to every input lot and forward to every first customer, reconcile the quantities against a tolerance and time it against your target.
- ISO 9001 internal audit checklist (production area)46 audit questions for the production floor in 11 processes, each with its ISO 9001:2015 clause, what evidence to look for and the sample to take, plus five defined grades, a findings log, a finding report and a summary by clause.
- Plan for every part (PFEP) templateOne row per part: supplier, pack, container, usage, lead time and locations, with ABC classes, market and line kanban counts and a lineside space check.
- Food plant GMP inspection checklist (21 CFR 117 subpart B)55 checks in the order of 21 CFR 117 subpart B, each citing its paragraph and saying what to look at, with a grade, finding, owner and due date; results by section and grade, a walk route and a bakery example.
- Master sanitation schedule with pre-op verificationA master list of cleaning tasks by area and equipment with frequency, chemical, lockout, who and next due date, a weekly on-time count, and the pre-operational verification log with a release step.
- Changeover matrix templateA from-to matrix of changeover minutes with the clean each transition needs (allergen, colour, format), and a weekly planner that totals the order and suggests a shorter one.
- Measurement uncertainty budget templateA GUM uncertainty budget: Type A and B rows, divisors by distribution, sensitivity coefficients, uc, νeff, k from the t-table, U, TUR and a guard band check.
- Maintenance job plan templateOne job planned on one sheet: steps and craft hours, parts checked against stock, tools, lockout and permits, documents, a ready check for the schedule, and technician feedback.
- Video time study filming checklistA pre-shoot checklist and shot log for filming a time study on video: camera, light, people, settings, power and review.
- Reorder point and safety stock sheet (many parts)Safety stock, reorder point, order quantity and an order list for up to 500 parts, worked out from each part's own demand and lead time history.
- Energy use and EnPI trackerMonthly electricity, gas and fuel in one unit, a 12-month regression baseline, expected against actual energy for each month, an EnPI ratio, the running saving and the tests that say whether the model can be trusted.
- FIFO lane sizing sheetThe maximum for a FIFO lane from the stop it must cover, in whole containers, with length, refill and wait checks for up to eight lanes.
- Pugh matrix templateCompare up to 8 concepts with a datum as better, same or worse on up to 12 criteria, flag must-haves, and carry the strongest into a second round.
- Condition monitoring route sheetA route of measuring points with baselines, alert and alarm limits, a check interval from the P-F interval, readings with rising and overdue flags, and an exceptions list worst first.
- Quad chart templateA project on one page in four boxes: idea and owner, problem, approach, and cost, schedule and result.
- Loss tree worksheetBreak one big loss number into area, line, machine, loss type and cause, and stop at the cause a team can fix.
- Equipment register templateOne row per asset, with hierarchy, criticality, PM strategy and owner, and a check that flags what is missing.
- Machine history record templateOne record per machine: components and their life, every breakdown and repair with cost, MTBF and MTTR, and a repair-or-extend check.
- Compressed air leak survey logWalk sheet, printable leak tags and a tracker that puts an annual cost on every leak and follows it to a verified fix.
- Defect detection matrix templateMap where each defect is created and where it is found, score the gap and move the check closer to the cause.
- Project savings validation checklistThe gate between a project's claim and a reported saving: 20 checks, a claims register and a six-month sustainment check.
- Life cycle cost analysis templateCompare up to three machines over ten years: price, energy, upkeep, failures and down time, discounted to present value.
- Equipment design review checklistGate reviews for a new machine before order, before build and before start-up, with a safety buy-off and a problems journal.
- Energy loss matrix templateSeven types of energy loss by six energy sources with a cost in each cell, an action plan and an idle-period shutdown checklist.
- Environmental compliance audit checklistAn internal environmental audit: 37 questions with what to look for, a findings log with classes and a score by section.
- APQP checklistThe five APQP phases as a checklist: deliverables, owners, due dates, gate reviews and an issues list.
- Out-of-control action plan (OCAP) templateA reaction plan for a control chart: the steps, what each signal means, who to call and a log of events.
- Quality inspection checklistAn in-process and final inspection record: measured characteristics, visual checks, a decision and first pass yield.
- AQL sampling plan templatePick a sample size, read accept and reject numbers, record the defects and decide on the lot.
- MSA study workbookBias, linearity and stability study sheets for a gauge, with the arithmetic done and a guide to which study when.
- Incoming quality control stage sheetA register that shows how much control each purchased part has and plans the move from your dock to the supplier's process.
- Internal audit schedule templateA year of internal audits planned by risk: the programme, the register, the auditors and the findings.
- Approved supplier list templateThe list of suppliers you may buy from, with the evidence behind each, certificate expiry alerts and re-evaluation dates.
- Pest control inspection checklistA pest control walk-round for a food plant, with a log of traps and stations and action levels for each type of device.
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A shift handover sheet, a red tag log, a changeover checklist for one machine: if your team uses it on the floor, ask.