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Incident Report Template: Workplace Incident Example

An incident report records what happened, when and where, who was involved, the impact, what was done straight away and what will be done so it does not happen again. It is written from facts, in the order they happened, without blame: its job is to let someone who was not there understand the event and check that the follow-up actions get done.

Get these right before you write

  1. 1Write it the same day while memories are fresh, and use times, not “later”.
  2. 2Separate facts from guesses: “the valve was open” versus “the valve may have been left open”.
  3. 3Describe actions, not people: no blame, no adjectives.
  4. 4Every preventive action needs an owner and a date, or it will not happen.

Structure

The document opens with these headings and blanks.

Incident report: [short title]
Date and time: [...]
Location / system: [...]
Reported by: [...]
Severity: [...]
##Summary
[Two or three sentences: what happened and the impact.]
##Timeline
[...] | [...] |
##Impact
[Who or what was affected, how much, for how long.]
##Immediate actions
[...]
##Cause
[What is known; what is still being checked.]
##Preventive actions

A complete example

Written by the AI from this brief, exactly as the workbench would write yours:

An incident report by warehouse supervisor Diego Hernández about a minor injury on 14 March 2027 at 10:40 in aisle 7 of a distribution centre: a picker, Jonas Weber, slipped on stretch-wrap film left on the floor near a pallet that had been unwrapped at 10:15; he bruised his wrist, received first aid at 10:50 and returned to light duties; no lost time; the aisle was cleared and checked at 11:00; cause: the film was not put in the bin after unwrapping and the bin was 15 metres away; actions: a bin at the end of every aisle by 21 March (facilities, Aiko Tanaka), a reminder at the next shift briefing (Diego, 15 March), and floor checks added to the hourly walk (Diego, 15 March).

Incident Report: Slip on Stretch-Wrap Film in Aisle 7

Summary

On 14 March 2027 at 10:40, picker Jonas Weber slipped on a piece of stretch-wrap film left on the floor of aisle 7 at the distribution centre. He sustained a bruised wrist, received first aid, and returned to light duties the same day. There was no lost time. The film had been left near a pallet that was unwrapped at 10:15 and was not placed in the bin, which was 15 metres away. Corrective actions have been assigned to prevent a recurrence.

Incident Details

Item Detail
Date 14 March 2027
Time 10:40
Location Aisle 7, distribution centre [site name needed]
Type Slip, minor injury
Injured person Jonas Weber, picker
Reported by Diego Hernández, warehouse supervisor
Severity Minor – first aid only, no lost time

People Involved

  • Jonas Weber, picker – slipped and bruised his wrist.
  • Diego Hernández, warehouse supervisor – reported the incident and arranged first aid and clearance of the aisle.
  • First aider – [name needed].
  • Person who unwrapped the pallet at 10:15 – [name needed].

Timeline

Time Event
10:15 A pallet in aisle 7 is unwrapped. The stretch-wrap film is left on the floor beside the pallet rather than placed in the bin.
10:40 Jonas Weber slips on the film while picking in aisle 7 and bruises his wrist.
10:50 Jonas Weber receives first aid.
[time needed] Jonas Weber returns to light duties.
11:00 Aisle 7 is cleared of film and checked by the supervisor.

Impact

  • Injury: Bruised wrist to Jonas Weber. Treated with first aid; no medical referral recorded [confirm].
  • Lost time: None. The employee returned to light duties on the same shift.
  • Operations: Aisle 7 was unavailable for approximately 20 minutes while it was cleared and checked. [impact on throughput needed, if any]
  • Property/equipment: No damage reported.

Immediate Actions Taken

  1. First aid was provided to Jonas Weber at 10:50.
  2. Jonas Weber was placed on light duties for the remainder of the shift.
  3. The film was removed from aisle 7 and the aisle was checked for further hazards at 11:00.
  4. The incident was reported by Diego Hernández. [report submission time needed]

Cause

Direct cause

Jonas Weber slipped on stretch-wrap film lying on the floor of aisle 7.

Contributing factors

  • After the pallet was unwrapped at 10:15, the film was not placed in a waste bin.
  • The nearest bin was 15 metres from the pallet, which made disposal inconvenient and increased the likelihood that film would be left on the floor.
  • The film remained on the floor for approximately 25 minutes without being noticed or removed, indicating a gap in routine floor checks.

Preventive Actions

# Action Owner Due date Status
1 Install a waste bin at the end of every aisle so film can be disposed of immediately after unwrapping. Aiko Tanaka, Facilities 21 March 2027 Open
2 Remind all staff at the next shift briefing that film must be placed in a bin straight after unwrapping and never left on the floor. Diego Hernández 15 March 2027 Open
3 Add floor checks for debris and film to the hourly supervisor walk. Diego Hernández 15 March 2027 Open

Follow-Up

  • Confirm completion of the actions above and update this report. [review date needed]
  • Check with Jonas Weber on [date needed] that the wrist has healed and he has returned to full duties.

Report prepared by: Diego Hernández, Warehouse Supervisor Date of report: [date needed]

Names, figures and dates in the example are made up for illustration.

How it works

  1. 1Open the template: a document with the skeleton and the brief appears.
  2. 2Add one line about your case to the brief, or attach your notes as sources, and press First draft.
  3. 3Edit directly, or ask the AI to tighten, expand or translate any passage; every AI change is reviewed before it lands.

Questions

Can I use the example as it is?
The example shows the shape and tone; its names and figures are made up. Open the template and give the AI your own facts, and it writes yours in the same shape.
Does it work in English and Chinese?
Yes. The document is written in the language of your brief, and any passage can be translated afterwards.
Is it free?
Writing is billed by the tokens used, usually a few credits per draft; the template, the skeleton and the editor cost nothing.

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