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HR & Recruiting
Workplace Accident Report
Document injuries and safety incidents on the spot — with photos and exact location.
Use this template14 fields · Free · Customize before publishing
What this form looks like
Preview · not interactiveWorkplace Accident Report
Document injuries and safety incidents on the spot — with photos and exact location.
Your name (person reporting)*
Injured or affected person*
Enter your own name if you were the one injured.
Date of incident*
Pick a date📅
Time of incident*
Pick a date📅
As close as you can remember.
Where did it happen?*
Allow location access to pin the exact spot — especially useful on sites, warehouses, and in the field.
Type of incident*
Select…▾
Please describe the incident type
e.g. manual handling strain
How serious was it?*
Near miss — no one was hurt
Minor — first aid was enough
Moderate — medical treatment needed
Serious — emergency care or time off work
What happened?*
Witnesses (optional)
Names of anyone who saw what happened
Photo of the scene (optional)
Take a photo right now if it is safe to do so — conditions change fast.
Additional documents (optional)
⬆ Drop a file or click to upload
Medical notes, equipment logs, or extra photos.
Was first aid given?*
Yes
No
Reporter signature*
Sign here
Confirms this report is accurate to the best of your knowledge.
Submit