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Incident Reporting Template

Author: Novade Solutions

Improve safety and compliance with the Incident Reporting Template, best linked with Root Cause and Action Plan Subforms.

Published on: 9/25/2025

Incident Reporting Template

General Information

Location

Incident Title

Incident Date & Time

*Do the GMRs apply or is this a work related incident?

Incident Type

Hazard

Hazard Source

Party Involved

Sub Contractors/Service Provider Company

Incident Description/Timeline

Injury / Damage Data

Affected Persons Name

Affected Persons FIN No.

Affected Persons Employer

Man Days Lost

MC Date From

MC Date Until

Circumstances

Animal Related

Asset Property

Contact with Hot or Caustic Substances

Cut or Puncture

Electrical Incident

Electrical Incident - Other (Pls specify)

Environmental

Environmental - Other (Pls specify)

Excavation Collapse

Excavation Collapse - Other (Pls specify)

Exposure to Toxic Chemicals, Gases or Substances

Exposure to Toxic Chemicals, Gases or Substances - Other (Pls specify)

Failure of Lifting Equipment

Failure of Permanent/Completed Structure

Failure of Pressurised System or Explosion

Failure of Pressurised System or Explosion - Other (Pls specify)

Failure of Temporary Structure

Failure of Temporary Structure - Other (Pls specify)

Failure of Work Equipment (non lifting)

Failure of Work Equipment (non lifting) - Other (Pls specify)

Fall of Materials <2m/6ft

Fall of Materials <2m/6ft - Other (Pls specify)

Fall of Materials >2m/6ft

Fall of Materials >2m/6ft - Other (Pls specify)

Fall of Person <2m/6ft

Fall of Person <2m/6ft - Other (Pls specify)

Fall of Person >2m/6ft

Fall of Person >2m/6ft - Other (Pls specify)

Foreign Object in Eye

Foreign Object in Eye - Other (Pls specify)

Health

Health - Other (Pls specify)

Major Fire (requiring emergency services)

Major Fire (requiring emergency services) - Other (Pls specify)

Minor Fire (manageable by site team)

Minor Fire (manageable by site team) - Other (Pls specify)

Manual Handling

Manual Handling - Other (Pls specify)

Personal Contact with Machinery

Personal Contact with Machinery - Other (Pls specify)

Psychosocial Hazards

Psychosocial Hazards - Other (Pls specify)

Public Health Issue

Public Health Issue - Other (Pls specify)

Service Strike (damage/disruption)

Service Strike (damage/disruption) - Other (Pls specify)

Significant Security Threat

Significant Security Threat - Other (Pls specify)

Slip or Trip

Slip or Trip - Other (Pls specify)

Stepping On or Striking Against

Stepping On or Striking Against - Other (Pls specify)

Vehicle/Equipment incident

Vehicle/Equipment incident - Other (Pls specify)

Vehicle/Equipment Incident Rollover

Vehicle/Equipment Incident Rollover - Other (Pls specify)

Violence/Anti-social behaviour/Security

Workplace Activity

Immediate Actions

*Reportable to Relevant Authorities

Upload supporting documents

Document.pdf

Sheets.xlsx

Critical Incident

*Could the event have had the potential to result in a LARGE or VERY LARGE impact?

*Did the absence, failure or inadequacy of a GMR risk event preventative and mitigating control(s) contribute to the incident

Comment

*Is this Incident critical?

Critical Incident Level

If Incident is NOT critical, please click "Mark as Closed" button

Assign Investigation Action Plan

Person Responsible (Investigator)

Due Date

Additional Details

Incident Investigation

Lead Investigator

Incident Owner

Investigation Team / Analysis Facilitators / SME /Technical Experts

Date of investigation

Incident Details

Description

Other details

Immediate Cause

Contributing Factors

Organizational Factors

Job Factors

Job Factor - Other (Pls specify)

Personnel Factors

Personnel Factors - Other (Pls specify)

Insert Root Cause [Subform]

Assign an Action Plan

Insert Action Plan [Subform]

Person Responsible (Action Plan)

Please ensure Corrective/Preventive Action Plan has been conducted in Action Plan subform(s)

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Incident Reporting Template

General Information

Location

Incident Title

Incident Date & Time

*Do the GMRs apply or is this a work related incident?

Incident Type

Hazard

Hazard Source

Party Involved

Sub Contractors/Service Provider Company

Incident Description/Timeline

Injury / Damage Data

Affected Persons Name

Affected Persons FIN No.

Affected Persons Employer

Man Days Lost

MC Date From

MC Date Until

Circumstances

Animal Related

Asset Property

Contact with Hot or Caustic Substances

Cut or Puncture

Electrical Incident

Electrical Incident - Other (Pls specify)

Environmental

Environmental - Other (Pls specify)

Excavation Collapse

Excavation Collapse - Other (Pls specify)

Exposure to Toxic Chemicals, Gases or Substances

Exposure to Toxic Chemicals, Gases or Substances - Other (Pls specify)

Failure of Lifting Equipment

Failure of Permanent/Completed Structure

Failure of Pressurised System or Explosion

Failure of Pressurised System or Explosion - Other (Pls specify)

Failure of Temporary Structure

Failure of Temporary Structure - Other (Pls specify)

Failure of Work Equipment (non lifting)

Failure of Work Equipment (non lifting) - Other (Pls specify)

Fall of Materials <2m/6ft

Fall of Materials <2m/6ft - Other (Pls specify)

Fall of Materials >2m/6ft

Fall of Materials >2m/6ft - Other (Pls specify)

Fall of Person <2m/6ft

Fall of Person <2m/6ft - Other (Pls specify)

Fall of Person >2m/6ft

Fall of Person >2m/6ft - Other (Pls specify)

Foreign Object in Eye

Foreign Object in Eye - Other (Pls specify)

Health

Health - Other (Pls specify)

Major Fire (requiring emergency services)

Major Fire (requiring emergency services) - Other (Pls specify)

Minor Fire (manageable by site team)

Minor Fire (manageable by site team) - Other (Pls specify)

Manual Handling

Manual Handling - Other (Pls specify)

Personal Contact with Machinery

Personal Contact with Machinery - Other (Pls specify)

Psychosocial Hazards

Psychosocial Hazards - Other (Pls specify)

Public Health Issue

Public Health Issue - Other (Pls specify)

Service Strike (damage/disruption)

Service Strike (damage/disruption) - Other (Pls specify)

Significant Security Threat

Significant Security Threat - Other (Pls specify)

Slip or Trip

Slip or Trip - Other (Pls specify)

Stepping On or Striking Against

Stepping On or Striking Against - Other (Pls specify)

Vehicle/Equipment incident

Vehicle/Equipment incident - Other (Pls specify)

Vehicle/Equipment Incident Rollover

Vehicle/Equipment Incident Rollover - Other (Pls specify)

Violence/Anti-social behaviour/Security

Workplace Activity

Immediate Actions

*Reportable to Relevant Authorities

Upload supporting documents

Document.pdf

Sheets.xlsx

Critical Incident

*Could the event have had the potential to result in a LARGE or VERY LARGE impact?

*Did the absence, failure or inadequacy of a GMR risk event preventative and mitigating control(s) contribute to the incident

Comment

*Is this Incident critical?

Critical Incident Level

If Incident is NOT critical, please click "Mark as Closed" button

Assign Investigation Action Plan

Person Responsible (Investigator)

Due Date

Additional Details

Incident Investigation

Lead Investigator

Incident Owner

Investigation Team / Analysis Facilitators / SME /Technical Experts

Date of investigation

Incident Details

Description

Other details

Immediate Cause

Contributing Factors

Organizational Factors

Job Factors

Job Factor - Other (Pls specify)

Personnel Factors

Personnel Factors - Other (Pls specify)

Insert Root Cause [Subform]

Assign an Action Plan

Insert Action Plan [Subform]

Person Responsible (Action Plan)

Please ensure Corrective/Preventive Action Plan has been conducted in Action Plan subform(s)

Record incidents, ensure compliance, and improve workplace safety with this Incident Reporting Template for contractors and site teams.