Construction Incident Report Form

Information you will need

• Who’s filing the report?
• What’s their title?
• What’s the date of the incident?
• At what time did the incident occur?
• Where did the incident occur?
• Did the incident involve an accident or injury?
• Did the incident involve a near miss?
• Did the incident involve an equipment failure?
• Did the incident involve property damage?
• Did the incident involve worker misconduct?
• Did the incident involve another type of event or adverse action?
• What’s the incident category? (if applicable)
• What happened?
• What time of day did the incident occur?
• What’s the name of the person involved?
• What’s the person’s phone number?
• What’s the person’s email?
• What’s the address of the person involved?
• What’s the name of the second person involved? (if applicable)
• What’s the second person’s phone number?
• What’s the second person’s email?
• What’s the address of the second person involved?
• What’s the name of the third person involved? (if applicable)
• What’s the third person’s phone number?

…and 32 more fields in the PDF.

The form includes 2 signature lines, a witness section.