Business Services Apps

Incident Report Form

No matter where incidents take place, have responders capture everything required for insurance and legal documentation. Have Human Resources and Management immediately notified of accidents in the workplace, on campus, or off-site. Document everything and everyone involved in the incident the first time. Capture photos and keep them in the cloud so nothing is lost in transport or in communication. Verify correct information is being captured when information is available. Ensure proper documents and corrective action is being taken place as a result of this incident.

Incident Report Form iPhone, iPad Incident Report Form Android Incident Report Form Web, Desktop
Incident Report Form

Information about person involved in the incident

Name

Home Address

Type

Home Phone Number

Mobile Phone Number

Information of Incident

Date of Incident

Time

Police Notified

Set Location of Record to the Location of the incident.

More information on location

Description of Incident

Were there any witnesses to the incident?

Witnesses

Name

Home Address

Phone Number

Was the individual injured If so, describe the injury (laceration, sprain, etc.), the part of body injured, and any other information known about the resulting injury(ies).

Was medical treatment provided?

Where was treatment provided?

Photos of Incident

Reporter Information

Name of Individual Submitting Report

Signature

Date Report Completed

FOR OFFICE USE ONLY

Report Received by

Received Date