"Employee Incident Report Form"

What Is an Employee Incident Report Form?

An Employee Incident Report Form is a document that is supposed to be used by an employee when any kind of incident has happened to them. The purpose of the application is to provide information about the incident to an employer. Any negative situation that affects a worker's job performance or health must be reported to their hirer.

Alternate Name:

  • Employee Incident Report Letter.

Generally, an Employee Incident Report is developed by the company themselves and is used by individuals who work there. Employees use the document when they want to report an assault, harassment, injuries, different types of accidents, and other negative situations that have happened in their workplace.

An Employee Incident Report template can be downloaded below.

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How to Type Up an Incident Report for an Employee?

While developing an application, an employer should make sure they did not forget to include the most important parts. An Employee Incident Report format should contain sections, which include the following:

  • Information about the reporter. In the first part of the document, a filer who reports an accident must enter their full name, gender, date of birth, telephone number, their job title, department, and address;
  • Information about any people involved in the incident. Here an applicant must designate the names of the persons who were involved in the incident, their genders, telephone number, etc. (if applicable);
  • Data about an incident. Employees use this part of the application to state factual information about the incident, such as the date and time of the incident, place of the incident, etc.;
  • Description of an incident. In this part of the document, filers should thoroughly describe the incident that took place. They should provide the employer with details on the incident, reporting everything they know;
  • Additional information. This section of the application can be used to designate any types of additional information, that in a worker's opinion, can be helpful or important for the employer;
  • Date and signature. To state that the information presented in the document is valid and true, an individual must sign the document and date it.

A business can change the structure of the application and add other parts to it. They can also develop different kinds of reports for various kinds of negative situations. For example, a company can use a sexual harassment complaint form, accident injury report form, security incident report, etc.

An Employer Accident Report can be accompanied with photographs, witness statements, and other forms of evidence that can help the employer. After the company receives the documents, examines them, and investigates the situation, they should take measures to resolve the situation. All reports should be systematized and kept in the archive for later analysis, if needed.


Related Forms and Templates:

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Download "Employee Incident Report Form"

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Employee Incident Report
___________________________
___________________________
Reported By
Title/Role
___________________________
___________________________
Date of Report
Incident Number
Employee Incident Information
Date of Incident: _________________
Date of Type: ____________________
Employee Name: _________________
Employee Role: __________________
Location: _____________________________________________________________
Street Address
_____________________________________________________________________
City
State
ZIP Code
Specific Area of Location (if applicable): ___________________________________
Incident Description (including any events leading to or immediately following the
incident):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Employee Explanation of Events:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Resulting Action Executed, Planned, or Recommended:
_____________________________________________________________________
©​ ​ ​ ​
T EMPLATEROLLER.COM​
Employee Incident Report
___________________________
___________________________
Reported By
Title/Role
___________________________
___________________________
Date of Report
Incident Number
Employee Incident Information
Date of Incident: _________________
Date of Type: ____________________
Employee Name: _________________
Employee Role: __________________
Location: _____________________________________________________________
Street Address
_____________________________________________________________________
City
State
ZIP Code
Specific Area of Location (if applicable): ___________________________________
Incident Description (including any events leading to or immediately following the
incident):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Employee Explanation of Events:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Resulting Action Executed, Planned, or Recommended:
_____________________________________________________________________
©​ ​ ​ ​
T EMPLATEROLLER.COM​
_____________________________________________________________________
_____________________________________________________________________
Name/Role/Contact of Parties Involved:
1. _______________________________________________________________
2. _______________________________________________________________
3. _______________________________________________________________
Name/Role/Contact of Witnesses:
1. _______________________________________________________________
2. _______________________________________________________________
3. _______________________________________________________________
Was a police report filed?
❏ Yes
❏ No
___________________
___________________
___________________
Employee Name
Reporting Staff Name
HR Rep. Name
___________________
___________________
___________________
Employee Signature
Reporting Staff Signature
HR Rep. Signature
___________________
___________________
___________________
Date
Date
Date
©​ ​ ​ ​
T EMPLATEROLLER.COM​
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