Incident Report Template for Manufacturing

# Incident Report Template - Manufacturing

## Purpose
Complete within 24 hours of any incident to comply with WHS obligations and prevent recurrence.

## When to Use
A formal incident report template for documenting workplace incidents, near-misses, or safety events with root cause analysis 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 Notion)

---

## Incident Report

**Report #:** [INC-001]
**Date of Report:** [Date]
**Date of Incident:** [Date]
**Time of Incident:** [Time]
**Location:** [Specific location, e.g. Warehouse, Bay 3]
**Site Address:** [Full address]

---

### Incident Classification

| Field | Detail |
|-------|--------|
| Incident type | [Injury / Near Miss / Property Damage / Environmental / Security / Other] |
| Severity | [Critical / Serious / Moderate / Minor] |
| Reportable to regulator | [Yes / No] |
| Workers compensation claim | [Yes / No / Pending] |

### People Involved

**Injured / Affected Person (if applicable):**

| Field | Detail |
|-------|--------|
| Name | [Full name] |
| Role / Title | [Position] |
| Employment type | [Employee / Contractor / Visitor / Member of public] |
| Date of birth | [DOB] |
| Contact number | [Phone] |
| Manager / Supervisor | [Name] |

**Witnesses:**

| Name | Role | Contact | Statement Obtained |
|------|------|---------|--------------------|
| [Name] | [Role] | [Phone/Email] | [Yes / No] |
| [Name] | [Role] | [Phone/Email] | [Yes / No] |

### Incident Description

**What happened:**
[Provide a clear, factual description of the incident. Include what the person was doing, what went wrong, and the immediate outcome. Write in plain language and stick to the facts. E.g. "At approximately 2:15pm, [Name] was carrying a box of stock (approx. 15kg) from the loading dock to the storage area. While descending the three steps at the rear entrance, they slipped on a wet surface and fell, landing on their right side."]

**Immediate response taken:**
[Describe what was done immediately after the incident, e.g. "First aid was administered on site. Ice applied to right wrist. [Name] was transported to [Medical Centre] by [colleague name] for assessment. Area was cordoned off and cleaned."]

**Injury / Damage details (if applicable):**
[Describe the nature and extent of any injury or damage, e.g. "Right wrist sprain confirmed by GP. No fracture identified on X-ray. [Name] given 3 days modified duties."]

### Environmental Conditions

| Factor | Detail |
|--------|--------|
| Weather | [Clear / Rain / Wind / Heat / N/A (indoors)] |
| Lighting | [Adequate / Poor / N/A] |
| Floor / Ground condition | [Dry / Wet / Uneven / Cluttered] |
| Noise level | [Normal / Excessive] |
| PPE worn | [List PPE worn at time of incident] |
| PPE required | [List PPE that should have been worn] |

### Root Cause Analysis

**Immediate cause(s):**
- [Immediate cause, e.g. Wet floor surface without signage]
- [Immediate cause, e.g. Carrying load obstructed view of steps]

**Contributing factors:**
- [Factor, e.g. No anti-slip coating on steps]
- [Factor, e.g. Drainage issue causing water pooling]
- [Factor, e.g. No handrail at rear entrance steps]

**Root cause:**
[The underlying reason the incident occurred, e.g. "Lack of a formal wet weather procedure for the loading dock area and insufficient physical controls (no anti-slip surface or handrail) on the rear entrance steps."]

### Corrective Actions

| # | Action | Responsible | Due Date | Status |
|---|--------|-------------|----------|--------|
| 1 | [Immediate action, e.g. Install anti-slip strips on rear steps] | [Name] | [Date] | [Open / Complete] |
| 2 | [Short-term action, e.g. Install handrail at rear entrance] | [Name] | [Date] | [Open / Complete] |
| 3 | [Process action, e.g. Develop wet weather loading dock procedure] | [Name] | [Date] | [Open / Complete] |
| 4 | [Training action, e.g. Toolbox talk on manual handling in wet conditions] | [Name] | [Date] | [Open / Complete] |
| 5 | [Review action, e.g. Inspect all entry/exit points for similar risks] | [Name] | [Date] | [Open / Complete] |

### Notifications

| Stakeholder | Notified | Date | Method |
|-------------|----------|------|--------|
| Direct supervisor | [Yes / No] | [Date] | [Phone / Email / In person] |
| WHS Officer / Manager | [Yes / No] | [Date] | [Phone / Email / In person] |
| Senior management | [Yes / No] | [Date] | [Phone / Email / In person] |
| Regulator (if applicable) | [Yes / No / N/A] | [Date] | [Online report / Phone] |
| Insurer | [Yes / No / N/A] | [Date] | [Phone / Email] |

### Report Sign-Off

| Role | Name | Signature | Date |
|------|------|-----------|------|
| Report completed by | _______________ | _______________ | _______________ |
| Supervisor / Manager | _______________ | _______________ | _______________ |
| WHS Officer | _______________ | _______________ | _______________ |

**Follow-up review date:** [Date, typically 30 days after incident to verify corrective actions are complete]

---

**Complexity:** simple | **Setup time:** 15 minutes | **Tools:** Asana, Notion

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