Incident/Injury Report Form for Construction
General Information
Date of Incident
Time of Incident
Location
Person Involved
Name
Job Title
Employee ID
Incident Details
Type of Incident
Injury
Property Damage
Near Miss
Other
Description of Incident
Apparent Cause
Injury Information
Nature of Injury
Body Part Injured
First Aid/Treatment Given
Witness(es) Information
Name(s) of Witness(es)
Corrective Actions
Actions Taken / Recommendations
Report Completed By
Name
Date
Signature