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Accident, Incident & Near-Miss Report Form

An incident report template — what happened, who was affected and the action taken, with RIDDOR check and sign-off.

Description

When something goes wrong — a burn, a slip, a gas scare, or a near miss that could have been serious — recording it properly matters, both to put it right and to show you take safety seriously. This report captures what you need: what happened, when and where, who was affected, and the action you took, clearly and at the time. It leads with the incident itself rather than paperwork, so it’s quick to complete while the detail’s fresh, and it includes a prompt on whether the incident is reportable under RIDDOR — the thing that’s easy to miss and serious to get wrong. A signed, dated record protects your staff, informs your risk assessment and demonstrates a responsible operation. Use it for every accident, incident or near miss, however minor. Free, brandable, with a RIDDOR prompt and sign-off built in.

Form fields

Everything the Accident, Incident & Near-Miss Report Form above collects — 10 fields, so you can see exactly what it captures before you make it your own.

Accident, Incident & Near-Miss Report

  • What are you reporting?

    Dropdown Icon
    Dropdown
  • Date it happened

    Date Icon
    Date
  • Time it happened

    Time Icon
    Time
  • Where did it happen?

    Short Answer Icon
    Short Answer
  • Who was involved or affected?

    Short Answer Icon
    Short Answer
  • What happened? Describe clearly

    Long Answer Icon
    Long Answer
  • Injury (if any) and first aid / action taken

    Long Answer Icon
    Long Answer
  • Is this reportable under RIDDOR?

    Yes/No Icon
    Yes/No
  • Reported by

    Short Answer Icon
    Short Answer
  • Signature

    Signature Icon
    Signature
Use Template Arrow Right Icon

Template FAQs

Common questions about the Accident, Incident & Near-Miss Report Form — what it captures, when to use it, and how to make it your own.

What should I report?

Any accident or injury, near miss, equipment or gas incident, or food safety incident. Recording even minor ones builds a picture and shows you manage safety.

What's the RIDDOR prompt for?

Certain workplace injuries and dangerous occurrences must be reported to the HSE under RIDDOR. The form prompts you to consider whether this one qualifies.

Why record near misses too?

Because a near miss is a warning. Recording it lets you fix the cause before it becomes an actual accident.

What detail should I capture?

What happened, when and where, who was affected, any injury and the first aid or action taken — clearly and at the time, while it’s fresh.

Why sign the report?

A signed, dated record is stronger evidence and makes clear who reported it and when.

Is the template free?

Yes — free with a Fun Forms account and fully brandable.