Incident Reporting Registry: Template and Example

Published 16/01/2022

As it suggests, it is a register that contains a list of injuries, near misses, accidents, and misfortunes that happen in a workplace within a given period. It provides historical information for reference and the measures implemented to mitigate the casualties. The report is made of questions that are answered in the yes/ no buttons and comments section.

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Components of Incident Reporting Registry

Personal information

Whether employee, contractor, shareholder, supplier or visitor, the affected person's information is recorded under personal information. The data collected include; name, phone number, gender, residential area, department, and date of birth. The victim signs the form as proof.

Description of injury, near miss, or risk

The information recorded here pertains to the nature of the accident or near-miss. The data include; date and time occurred, time reported, the person reporting the incident, location, condition of the area of work, and a brief description of the incident.

Nature of incident

On the buttons provided, the nature of the incident is marked. The incident can either be; injury, hazard, illness, or near miss. After making either of these, the type of incident is marked. The buttons contain bone fractures, dislocation, internal injuries, and foreign objects in the eye, nose, or ear, toxic chemicals, burns, and skin cuts.

Location of injury

The exact part(s) affected is marked on the respective button. On top of that, the affected area is drawn on a human picture provided - the picture aids in better understanding the injured part.

Injury treatment and incident reporting

The kind of treatment given to the victim is noted under this section. The victim can either be given first aid, referred to a doctor, treated and returned to work, admitted, or advised to go home. If referred to a hospital, the doctor gives his comments and signs the form.

Corrective action

The action taken to mitigate the incident is outlined here, the time taken, the accountable person, and the comments. On the last page, the responsible person signs and leaves his remarks.

Investigation report

- The company investigates the incident and the condition of the victim at the time of injury. The following questions are included in the report;
- What was the employee doing at the time of the incident?
- What exactly caused the injury, illness, or near-miss?
- Was the employee qualified to undertake the work?
- Was the employee adequately supervised?
- Was the employee in protective garments at the time of injury?
- Were the protective garments damaged?
- Was the employee provided with safe working equipment?
- Was the employee working as per the documented standard methods?
- Was the working environment free from obstructions?
- Was the area adequately lit?
- Was the area well-ventilated?
- Was the area easily accessible?
- Who witnessed the incident?
- Uses of incident reporting registry

Reference tool

The incident registry provides a reference tool because incidents are recorded in real-time. Incidents that occurred a long time are cross-checked to determine whether the action taken worked.

Accountability tool

The company draws attention to the incident when it is documented. Whether the mishap happened due to an employee mistake or machine malfunction, the company is held liable for the incident.

Discover trends of near misses and hazards

Since the registry contains all incidents across the company, it is easier to identify common risks from different departments. Recurring near misses are identified and addressed as a threat to employees.

Robust health and safety protocols

When the employees report all possible risks in their workplace, adequate mitigation measures are implemented and enforced. Recurring threats are treated with attention and robust measures put in place.

Correction tool

The company uses the registry to mitigate possible risks that could happen in the future. By so doing, the company's resources are saved, and the production rate improves.

Saving a company's resources and time starts at providing a safe working environment. Every company must implement an incident report registry. Employees feel safe and produce more when they are assured of safety.


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