How To Write a Workplace Incident Report [With Examples]

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In order to manage Health and Safety effectively an organisation needs to be aware of and record all incidents that can occur in the workplace. The term “incident” refers to an unexpected event that does not necessarily cause injury or damage but has the potential to cause harm.

All incidents can be prevented, so investigations must be carried out when an incident occurs with the belief that the cause will be identified, recorded in a workplace incident report and then measures and corrective actions can be put in place to prevent reoccurrence, or prevent similar incidents from occurring. Incident reporting helps prevent assets and property damage and saves employee’s lives.

incident report sample

Why is incident reporting so important 

The purpose of a incident reporting system and activities is not to find fault or lay blame, but to identify the basic and real causes of an incident, in order to ensure that safety measures and controls are put in place to prevent further occurrences or re-occurrences. Information from the investigation should be recorded on an incident report form, but not used to unnecessarily discipline anyone. This problem-solving approach will encourage witnesses to be open and share everything they know with investigators. 

An incident investigation and incident reporting should:

• Determine what actually happened, the date and time, the people involved and the injuries sustained;

• Determine the root causes and contributory factors of an incident;

• Identify any unsafe conditions, acts or procedures;

• Help management to identify practical corrective actions;

• Determine whether due diligence was practiced, or not;

• Show that management is committed to having an effective workplace incident reporting system in place.

The intent of the report is to effect change. If, after an investigation, no recommendations or actions are taken to improve safety and health at the workplace, it is likely incidents will continue to happen and workers could accuse the employer and Health and Safety Committee of irresponsibility. A detailed report indicating specific recommendations is critical to the effectiveness of prevention of future incidents at the workplace. 

The extracts below are law and must be adhered to by all companies, employers and workplaces. 

The OHS Act Section 24 states: 

“Each incident occurring at work or arising out of or in connection with the activities of persons at work, or in connection with the use of the plant or machinery, shall, within the prescribed period and in the prescribed manner, be reported to an inspector by the employer or the user of the plant or machinery concerned, as the case may be.”

The OHS Act General Administrative Regulations Section 9 states:

An employer shall keep at a workplace an incident record in the form of Annexure 1, for a period of at least three years, of all incidents they are required to report. The investigation must be finalised as soon as is reasonably possible. Recommendations recorded on the Annexure 1 document and corrective actions should be implemented.

how to write an incident report

Key Process, Elements and Aim of Incident Reporting 

The process, elements and aim of incident reporting for the investigator and team is to:

• Piece together all the events in a chain;

• Review witness statements;

• Select all the relevant information that has been collected;

• Piece together facts;

• Identify deviations from standards, procedures and instructions;

• Identify patterns, trends and inconsistencies;

• Draft a report with findings and review the conclusions made;

• Formulate recommendations to be included in the action plan.

If the organisation has developed a specific form for reporting incidents, complete such a form for each incident, or Annexure 1 is a form that can be used and found in the General Safety Regulation and is a format recommended by the DOEL. 

workplace incident report sample

Annexure 1 – DOEL – Workplace incident Report – Annexure 1  

The Annexure 1 document below is copied directly from the General Administrative Regulation 

(ACT NO 85 OF 1993)
1.  Name of employer
2.  Name of affected person 
3.  Identity number of affected person
4.  Date of incident
5.  Time of incident
6.  Part of body affected Head Neck Eye
Trunk Finger Hand
Arm Foot Leg
Internal Multiple

7.  Effect on person
Sprains or strains Contusion or woundsFractures
Burns Amputation Electric shock
Asphyxiation Unconsoiusness Poisoning
Occupational Disease

8.  Expected period of disablement

0-13 days

2-4 weeks

4-16 weeks
16-52 weeks52 weeks or permanent disablement Killed

9. Description of occupational disease

10.  Machine/process involved/type of work performed/exposure**
11.  Was the incident reported to the Compensation Commissioner and Provincial Director?Yes        No
12.  Was the incident reported to the police?*Yes       No
13.  SAPS office and reference 
* To be completed in case of a fatal incident.
** In case of a hazardous chemical substance, indicate substance exposed to.
1.  Name of investigator 
2.  Date of investigation
3.  Designation of Investigator

4.  Short description of incident

5.  Suspected cause of incident
6.  Recommended steps to prevent a reoccurrence 

Signature of Investigator

Signature of Employer

Signature of Chairperson of Health and Safety Committee
incident report example

Incident Report Sample or Incident Report Example

Below is an “Incident Report Sample” or “Incident Report Example” that could be used as a starting point and then built on and included with or to the DOEL Annexure 1, to end up with a comprehensive workplace incident report.    

Incident Investigation Report Form 
Date of the Incident:
Location of the Incident:
Investigator Names: Employer:Employee:H&S Representative:
Injured Persons name:
Type of Injury to personSprains and strainsContusion or woundsFractureBurnsAmputation
Electric shockAsphyxiationUnconsciousnessPoisoningOccupational Disease
Part of body affected / injuredHead or neckEyeTrunkFingerHand
Expected period of disablement0 – 13 days2 – 4 weeks>4 – 16 weeks>16 – 52 weeks>52 weeks or permanent disablementKilled
Brief explanation of what happened at the incident: 

The nine steps that should be followed or complete during an Incident Investigation:
1: Immobilise the scene 
2: Prepare for the investigation
3: Collect evidence
4: Analyse evidence
5: Identify the root cause
6: Implement control measures
7: Formulate the report
8: Communicate the report to the employer and DOL
9: Follow up
Who reported the incident:
Evidence Collected on scene:

Were there witnesses, who, contact details and what did they say:   

What were the sequence of events leading up to the incident: 

What is the root causes of the incident: 
What control measures can be implemented:

Additional information:  

Was the incident reported to the police or other authorities?YesNo
Date of the incident investigation report completion:
Investigator Signatures:
OHS Manager & Chairperson Signatures


Incidents usually result from unsafe acts and conditions and these unsafe acts and conditions often arise because of defects in the health and safety management system. 

Health and safety issues and concerns in the workplace are important and can cost the lives of others. It is the duty of each and every one of us to report any dangers no matter how small and insignificant we may think they are. Rather be safe than sorry. Be involved in the workplace incident report process and help prevent future incidents and accidents. 

Attend the Absolute Health Services incident investigation course to build up your knowledge and skills in workplace incident reporting.

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