It captures what nearly happened
An accident book records injuries. This form asks what could have happened, so the near miss before the accident gets written down.
Incident, near-miss and accident report form
One form for every injury, near miss, dangerous occurrence and damage event, completed by the person who saw it and reviewed by the person who owns the fix. It also shows whether RIDDOR is likely to apply (RIDDOR 2013 covers Great Britain; in Northern Ireland, report to HSENI under RIDDOR (Northern Ireland) 1997).
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What this template covers
It flags RIDDOR on the spot
A work-related test and seven yes or no questions show whether HSE is likely to need telling, and the form holds the deadline and the reference number once it is.
It assigns the fix
Every corrective action leaves the form with an owner and a due date, and the record does not close until each one is done.
Incident, near-miss and accident report
1. About this form
This form is completed by the person who saw or was involved in the incident, or by their supervisor, on the same day. It covers injuries, ill health, near misses, dangerous occurrences and damage to property, so that the event that nearly hurt someone is recorded with the same care as the one that did.
The completed form goes to the health and safety lead, who makes the RIDDOR decision in section 5, assigns the corrective actions in section 7 and signs it off. Where there is an injury, the accident book entry is made as well. Keep the form for at least three years.
2. Reporter and incident
- Name
- The person completing the form, not necessarily the person injured.
- Role
- Job title and, for a contractor or visitor, the company they are with.
- Date and time of incident
- When it happened, not when the form was filled in; the RIDDOR clock starts here.
- Exact location
- Site, building, floor and spot, precise enough for someone else to stand in the same place.
- People involved
- Everyone directly involved, with employment status: employee, contractor, self-employed, member of the public.
- Witnesses
- Anyone who saw it, with a way to contact them while the memory is fresh.
3. What happened
- Type
- One of: injury, ill health, near miss, dangerous occurrence, damage. A near miss is an event that caused no harm this time but could have.
- Description of events
- What happened in the order it happened, in plain words, without guessing at the cause yet.
- What the person was doing
- The task underway and whether it was their routine work.
- Equipment, substances or vehicles involved
- Make, type and identifier where there is one, and whether it was being used as intended.
- Environmental conditions
- Lighting, weather, floor surface, noise, space, time pressure: anything about the setting that mattered.
4. Injury or harm
- Injured person and employment status
- Name and whether they are an employee, self-employed, a contractor or not at work; the status decides who must report.
- Nature of injury and body part
- What the injury is and where. A fracture confirmed by a doctor anywhere other than a finger, thumb or toe is a RIDDOR specified injury.
- First aid given
- What was done, by whom, and whether the person returned to work.
- Taken to hospital
- Yes or no, and whether for treatment or as a precaution. A non-worker taken directly from the scene to hospital for treatment of an injury from a work-related accident is reportable. Examinations and precautionary checks do not count.
- Expected days off
- Best estimate now, then update it. More than three days must be recorded under RIDDOR (the accident book can be that record); more than seven, excluding the day of the accident, must be reported to HSE within 15 days.
5. RIDDOR decision
The health and safety lead decides, on behalf of the responsible person under the Regulations: the employer for an injured employee, the person in control of the premises for anyone else and for a dangerous occurrence. This section follows RIDDOR 2013, which applies in Great Britain. [Northern Ireland: RIDDOR (Northern Ireland) 1997 applies instead and reports go to HSENI; check the categories and deadlines there.]
- Arising out of or in connection with work
- Did the injury or death result from an accident arising out of or in connection with work, such as the way the work was organized or carried out, the equipment or substances used, or the condition of the premises? If no, it is not RIDDOR-reportable as an injury: record why here and stop. Diseases and dangerous occurrences are assessed on their own terms below.
- Death, specified injury, over-seven-day injury, non-worker hospital case, occupational disease, dangerous occurrence or gas incident
- Tick any that apply. A tick means HSE is likely to need telling; a disease is reportable only once diagnosed in writing by a doctor. If none applies, record it here and stop.
- Report due by
- Without delay, with the report received within 10 days, for a death, specified injury, non-worker hospital case or dangerous occurrence; within 15 days of the accident for an over-seven-day injury; on diagnosis for a disease.
- HSE reference number
- The number issued when the online form is submitted. Download the copy and attach it.
- Accident book entry made
- Yes or no, with the entry date. Every injury goes in the accident book whether or not it is reported.
6. Causes
- Immediate cause
- The thing that directly caused the harm or near miss: the missing guard, the wet floor, the unsecured load.
- Underlying causes
- Why the immediate cause was there: the training not given, the inspection missed, the pressure to finish.
- Controls that were in place
- The precautions the risk assessment relies on, and whether they were being followed.
- Controls that failed or were missing
- Which precautions did not work, were not followed or were never there.
7. Actions
- Immediate action taken
- What was done on the day to make the area safe and stop a repeat.
- Corrective actions with owner and due date
- Each fix as its own line, with one named owner and one date. Unowned actions do not happen.
- Review date
- When someone will check that the corrective actions are done and have worked.
8. Sign-off
- Completed by
- Name, role and date.
- Reviewed by
- The health and safety lead or manager who made the RIDDOR decision, with the date.
- Date closed
- The date the last corrective action was confirmed done.
- Record retained until
- At least three years from the date of the incident; longer if a claim is possible.
A starting point to adapt to your organization, not legal advice.
Putting the form to work
A form that lives in a drawer records nothing. These six steps turn it into a system that catches the near miss, makes the RIDDOR deadline and shows HSE what you did.
Book a demoPut the form where the work is
A paper form in the site office is filled in after the shift, if at all. Put a QR code on the noticeboard, the forklift and the first aid box so the report starts on a phone, at the spot, in the minute after it happened.
Decide who gets it
Every completed form goes to one named person, the health and safety lead, the same day. Line managers see it too, but the decision on RIDDOR and the ownership of the fix do not sit with the person whose shift it happened on.
Start the RIDDOR clock at intake
Section 5 is answered on the day, not at the end of the week. A work-related specified injury or death, a non-worker taken directly to hospital for treatment, or a dangerous occurrence is notified without delay with the report received within 10 days. An over-seven-day injury has 15 days from the accident. Write the due date on the form.
Make near misses the habit
Ask for every near miss, then thank the people who report them. The goal is not a count. It is the second form that mentions the same corner, the same ladder or the same pallet, which is the warning you can still act on.
Review the forms monthly
Once a month, read every form together: what types, where, what causes repeated, which corrective actions are overdue. The pattern across twenty near misses tells you more than the detail of one injury.
Keep the HSE record
File the downloaded copy of each HSE submission with its form and reference number, and keep every form for at least three years. When an inspector asks what you did, the answer is the form, the actions and the dates.
Incident, near-miss and accident report FAQ
Who should fill in an incident report form?
The person who saw or was involved in the incident, or their supervisor, on the same day and ideally at the spot. The health and safety lead then completes the RIDDOR decision, the causes and the actions. The RIDDOR report itself is made by the responsible person under the Regulations, which for an injured employee is the employer; an injured person should not report to HSE themselves.
Should near misses be recorded?
Yes, on the same form as injuries. No law requires an internal near-miss record, and only the dangerous occurrences listed in Schedule 2 of RIDDOR have to be reported to HSE. The reason to record the rest is that a near miss is the only evidence you get about an accident before it happens, and a record of them is how a repeated hazard gets noticed.
Does an incident report replace the accident book or a RIDDOR report?
No. The accident book is a legal record of every injury at work, required where 10 or more people are employed at the premises. A RIDDOR report is the external report to HSE of the listed categories. The incident report is the organization's own investigation record, which also covers near misses and damage. An injury may need all three; the form tells you which.
How long must incident records be kept?
At least three years. RIDDOR requires a record of every reportable event to be kept for three years, and the Social Security (Claims and Payments) Regulations 1979 require each accident book entry to be kept for three years. Keep the incident form, the accident book entry and the downloaded HSE submission together, and keep them longer if a claim is possible.
What makes a good incident description?
Facts in order, without blame or guesses. What the person was doing, what happened step by step, what they were using, what the conditions were, and what could have happened if it had gone slightly differently. Write it the same day, name the witnesses, and keep the causes for the causes section, where the immediate cause and the underlying cause are recorded separately.
See the document become a process