Slips, Trips, and Falls Incident Report
Incident Details
Date of Incident
Time of Incident
Location of Incident
Type of Incident
Slip
Trip
Fall
Description of Incident
Injured Person
Name
Job Title
Contact Information
Description of Injury
Witnesses
Witness Name(s) and Contact Info
Cause & Preventive Action
Immediate Cause (e.g. wet floor, uneven surface, obstruction)
Corrective/Preventive Actions Taken
Report Completed By
Name
Date
Signature