Incident Report Form

A form for recording and reporting workplace safety incidents, such as injuries, illnesses, dangerous occurrences and near misses.

Record workplace incidents and meet your legal obligations with an Incident Report Form.

This editable form helps you document safety incidents in the workplace, supporting your duty to manage risks to health and safety under Australian WHS laws. It is strongly recommended for all workplaces, including low-risk environments, and meets the requirements of a Register of Injuries (a legal requirement for all workplaces in NSW). It is also suitable for use in all other Australian states and territories.

This simple, clean 4-page form helps you capture essential details and supports continuous improvement in your workplace safety systems.

Who is it for?

This form is ideal for businesses of all sizes and industries, from offices and retail to construction, manufacturing, healthcare, and hospitality, looking to improve incident reporting and meet WHS requirements.

When is it used?

This form should be used to document any safety incident at the workplace, not just when someone is injured. It can be used for incidents involving injury, dangerous occurrences (such as spills, collisions, fires, electric shock, or property damage), near misses, or instances of violence or aggression.

What’s included?

• Details of the injured person (if applicable)

• Details of the incident

• Identification of contributing factors

• Incident follow-up and corrective actions

• Employer sign-off

• Information on regulator notification (if required)

Meeting your legal requirements

Under WHS legislation, all Australian businesses have a duty to manage risks to health and safety. In NSW, all businesses must have a Register of Injuries. This form helps you meet those obligations by providing a clear, compliant record of incidents and actions taken, supporting legal compliance, incident analysis, and safety improvements.