Incident Report Form

This report is used to document all workplace incidents, including employee injuries, motor vehicle accidents, and property damage involving company or customer property. Accurate and timely reporting supports workers’ compensation and insurance claims, regulatory compliance, and ongoing safety improvement efforts.

This report must be completed by a supervisor or manager within 24 hours of being notified of an incident. All applicable sections must be completed. Sections that do not apply may be left blank or marked “N/A.” All information must be accurate, factual, and legible.