Incident Report Form for Manufacturing

# Incident Report Form - Manufacturing

## Purpose
Make available to all staff for immediate reporting of any workplace incident to comply with WHS requirements and prevent recurrence.

## When to Use
A detailed incident report form for workplace injuries, near-misses, property damage, or safety events with witness details and corrective actions.

## Instructions
1. Review the template below and familiarise yourself with the structure
2. Replace all [bracketed placeholders] with your manufacturing business details
3. Customise the tone and formatting to match your brand
4. Save in your preferred tool (Asana or Slack)

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## Incident Report Form

**Purpose:** Capture all details of workplace incidents immediately to comply with WHS legislation, support investigation, and prevent recurrence.

**Important:** Report all incidents as soon as practicable. For serious injuries, call 000 first, then complete this form within 24 hours.

### Section 1: Incident Details
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Report Date | Date | Yes | Auto-populated with today | DD/MM/YYYY |
| Incident Date | Date | Yes | Cannot be in the future | DD/MM/YYYY |
| Incident Time | Time | Yes | - | HH:MM (24hr) |
| Incident Location | Text | Yes | - | e.g., Warehouse, Bay 3 or Level 2 Kitchen |
| Site Address | Text | Yes | - | Full address of the site |

### Section 2: Incident Classification
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Type of Incident | Checkbox (multi-select) | Yes | Min 1 selected | Injury / Illness / Near Miss / Property Damage / Environmental / Vehicle / Other |
| Severity | Radio | Yes | - | Minor (first aid only) / Moderate (medical treatment) / Serious (hospitalisation, serious injury) / Notifiable (death, serious injury, dangerous incident) |
| Was the injured person an... | Radio | Yes | - | Employee / Contractor / Visitor / Member of the Public |

### Section 3: Injured Person Details
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Name of Injured Person | Text | Yes | - | Jane Smith |
| Job Title or Role | Text | No | - | Warehouse Operator |
| Contact Phone | Phone | Yes | - | 04XX XXX XXX |
| Date of Birth | Date | No | - | DD/MM/YYYY |
| Nature of Injury or Illness | Dropdown | Yes | - | Cut / Burn / Fracture / Sprain or Strain / Bruise / Concussion / Respiratory / Psychological / Other |
| Body Part Affected | Dropdown | Yes | - | Head / Eyes / Neck / Back / Arm / Hand / Leg / Foot / Chest / Multiple / Other |
| Description of Injury | Textarea | Yes | Min 20 characters, Max 1000 | Describe the injury or illness in detail... |

### Section 4: Incident Description
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| What happened? | Textarea | Yes | Min 50 characters, Max 2000 | Describe exactly what happened, including what the person was doing at the time, the sequence of events, and the immediate cause... |
| What activity was being performed? | Text | Yes | - | e.g., Lifting stock onto pallet, using angle grinder |
| What equipment or substances were involved? | Text | No | - | e.g., Forklift, ladder, cleaning chemicals |
| What conditions contributed? | Checkbox (multi-select) | No | - | Wet or Slippery Surface / Poor Lighting / Inadequate Training / Faulty Equipment / Fatigue / Time Pressure / Inadequate PPE / Other |

### Section 5: First Aid & Treatment
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Was first aid provided? | Radio | Yes | - | Yes / No |
| First aid provided by | Text | No | - | Name of first aid officer |
| Description of first aid | Textarea | No | Max 500 characters | Describe the first aid treatment provided... |
| Was medical treatment required? | Radio | Yes | - | Yes / No / Declined |
| If yes, where was the person treated? | Text | No | - | e.g., Westmead Hospital ED |
| Did the person return to work? | Radio | Yes | - | Yes, same day / Yes, modified duties / No, went home / No, hospitalised |

### Section 6: Witnesses
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Were there any witnesses? | Radio | Yes | - | Yes / No |
| Witness 1 Name | Text | No | - | - |
| Witness 1 Phone | Phone | No | - | 04XX XXX XXX |
| Witness 2 Name | Text | No | - | - |
| Witness 2 Phone | Phone | No | - | 04XX XXX XXX |

### Section 7: Photos & Evidence
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Photos of the Scene | File Upload | No | Max 5 files, 5MB each, JPG/PNG | Upload photos of the incident scene |
| Additional Documents | File Upload | No | Max 3 files, 5MB each | Upload any relevant documents |

### Section 8: Reporter Details
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Report Completed By | Text | Yes | - | Your name |
| Role or Position | Text | Yes | - | Your job title |
| Phone | Phone | Yes | - | 04XX XXX XXX |
| Signature (typed) | Text | Yes | - | Type full name as digital signature |

### Conditional Logic
- If "Severity" = "Notifiable", show prominent warning: "This incident may be notifiable to your state WHS regulator. Do not disturb the scene. Contact your WHS Officer and regulator immediately."
- If "Were there any witnesses?" = "Yes", show witness detail fields
- If "Type of Incident" includes "Near Miss", hide injured person details and show note: "Well done for reporting a near miss. These reports help prevent future injuries."

### Submission
- **Button text:** "Submit Incident Report"
- **Confirmation message:** "Incident report [Auto-Reference Number] has been submitted. Your WHS Officer and site manager have been notified. If this is a serious incident, please ensure the WHS regulator has also been contacted."
- **Notification:** Immediate Slack alert to WHS Officer and site manager, create investigation task in project management tool, email confirmation to reporter

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**Complexity:** simple | **Setup time:** 10 minutes | **Tools:** Asana, Slack, Zapier

Note: This template has been tailored for manufacturing businesses in Australia. Adjust terminology and compliance references to match your specific context.