Incident Form Template UK

The Incident Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring customizable and printable examples.

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Sample

Incident Form Template UK

Editable – Printable

PDF – 1 PDF – 2

Incident Form Template UK

1. Incident Information


2. Reporting Individual Information


3. Incident Type

4. Description of the Incident

5. Witness Information


6. Immediate Action Taken

7. Follow-Up Actions Required

8. Affected Individuals


9. Documentation and Evidence

10. Signatures



PDF

WORD

Examples

Incident Form Template UK (1)
Incident Details:
Date of Incident: [Date]
Time of Incident: [Time]
Location of Incident: [Location]
Reported By:
[Name of the Reporter]
[Job Title]
[Department]
[Contact Information]
Type of Incident:
[Select from options e.g. Accident, Near Miss, Property Damage, Other (specify)].
Description of Incident:
[Provide a detailed description of what happened, including circumstances and parties involved.
Witnesses:
[List any witnesses with their contact information.
Actions Taken:
[Detail any immediate actions taken in response to the incident, e.g., first aid administered, reporting to supervisory staff, etc.].
Follow-Up Actions Required:
[Specify any follow-up actions needed to prevent recurrence or further investigation, if applicable.]
Additional Notes:
[Any other relevant information or observations about the incident.]
Signature:
[Signature of the Reporter]
[Date and Time of Reporting]
Incident Form Template UK (2)
Incident Overview:
Incident Reference Number: [Reference Number]
Date of Incident: [Date]
Time of Incident: [Time]
Location of Incident: [Location]
Reported By:
[Name of the Reporter]
[Position]
[Contact Number]
[Email]
Description:
[A comprehensive account of the incident, including what occurred and who was involved. Mention any equipment or materials relevant to the incident.]
Injuries Sustained:
[Detail any injuries to individuals involved, including names, if applicable.]
Immediate Actions Taken:
[Outline the steps taken immediately following the incident, such as calling emergency services or evacuating personnel.]
Preventative Measures:
[Discuss any measures that need to be implemented to prevent future incidents, such as training or equipment maintenance.]
Reporting Manager:
[Name of the Manager/Supervisor handling the incident report.]
Review and Investigation:
[Outline any investigation that will take place regarding the incident and who will be responsible.]
Signature of Reporter:
[Signature]
[Date]

Printable

PDF – 1 PDF – 2

Incident Form Template UK