Workplace Accident Investigation Template
Incident Details
Date of Incident
Time of Incident
Location
Reported By
Position/Department
Description of the Incident
People Involved
Name(s) of Injured Person(s)
Job Title(s)
Witness Name(s)
Accident Analysis
Describe What Happened
Immediate Causes
Underlying Causes
Injury/Illness Details
Type of Injury/Illness
Part of Body Affected
Treatment Provided
Corrective Actions
Immediate Actions Taken
Recommended Preventive Measures
Person Responsible
Completion Date
Investigator Information
Investigator Name
Date of Investigation