Free inspection template
Incident / Near-Miss Investigation Report
Document workplace incidents and near-misses from the scene: facts, witnesses, causal analysis, and corrective actions. Get a signed PDF ready to file with your OSHA records before the end of the shift.
Overview
What is a workplace incident investigation report?
A workplace incident investigation report documents what happened, who was involved, what caused it, and what will be done to prevent it from happening again. OSHA's incident investigation guidance emphasizes that investigations should identify root causes (the underlying system or management factors), not just the immediate actions that preceded the injury. OSHA Form 301 (29 CFR 1904) requires employers to complete a separate injury and illness incident report for each OSHA-recordable case within 7 days of learning of the incident.
This template covers the complete investigation workflow: incident classification and severity, the factual details, persons involved, an injury/illness section that appears only when a person was hurt, witnesses, sequence of events, causal analysis using the 5-Whys method, and a corrective-actions section structured around the hierarchy of controls. Evidence fields allow photos to be captured from the scene before it is disturbed. The template closes with investigator and management review signatures, producing a signed PDF that satisfies the OSHA 301 data requirements and doubles as an internal investigation record.
The checklist
Every checkpoint, in full
A read-only preview of the live template. Clone it to run the inspection on mobile, where each item records Pass, Fail or N·A with optional photos and notes.
NOTENote on Usage
This report follows OSHA's incident-investigation guidance and captures the data points on OSHA Form 301 (29 CFR 1904). Completing it does not by itself satisfy OSHA recordkeeping or reporting duties, nor does it guarantee a hazard has been eliminated. The employer remains responsible for recording injuries on the OSHA 300/301 forms where required, reporting fatalities and severe injuries to OSHA within the required time limits, and correcting the underlying hazards.
Report Information
4 checksDate of this report
Report prepared by (name and title)
Incident classification
Near-misses had the potential to cause harm but did not. Investigate them with the same rigor — they reveal hazards before someone is hurt.
Potential severity if it happened again
Judge the realistic worst-case outcome, not just what actually happened this time. A near-miss with high potential deserves a full investigation.
Incident Details
7 checksDate of incident
Time of incident
Location where it occurred
Be specific — building, floor, machine, or area.
Department or work area
Task or activity being performed at the time
Equipment, materials, or substances involved
What happened?
Describe the facts in plain language and in order. Stick to what was observed — save analysis of why for the Causal Analysis section.
Person(s) Involved
6 checksWas a person injured, made ill, or exposed?
If No, this is a near-miss or a property/environmental event — the injury detail section will stay hidden.
Name of affected person
Relationship to the company
Job title or role
Time in this job or experience level
New or recently reassigned workers are over-represented in incidents — note if relevant.
Time employee began work that day
Required by OSHA Form 301. Helps evaluate fatigue or shift length as a contributing factor — compare against the time of incident.
Injury / Illness Details
7 checksNature of injury or illness
e.g., laceration, sprain, burn, chemical exposure, fracture.
Body part(s) affected
Object or substance that directly harmed the person
OSHA Form 301 asks for the specific thing that caused the harm — e.g., "chemical splash from sodium hydroxide," "unguarded saw blade," "falling pallet." More specific than the equipment list in Incident Details.
Medical outcome
The most serious outcome that applies. This drives whether the case is OSHA-recordable.
Treatment provided by a licensed healthcare professional?
Estimated days away from work
Best estimate at time of report; update later if needed.
Likely OSHA-recordable?
Generally recordable if it involves medical treatment beyond first aid, restricted duty, days away, loss of consciousness, or a significant diagnosed condition. Confirm against 29 CFR 1904 with your recordkeeper.
Witnesses
3 checksWere there any witnesses?
Witness name(s)
Summary of witness accounts
Interview witnesses promptly and separately. Capture facts, not opinions about fault.
Sequence of Events
2 checksSequence of events leading up to the incident
Reconstruct the chain of events and conditions in the order they happened.
Conditions at the time
Lighting, weather, housekeeping, noise, time pressure, staffing, or anything unusual.
Causal Analysis
5 checksImmediate / direct cause(s)
The unsafe condition or action present at the moment of the incident — e.g., "floor was wet," "guard was removed."
Contributing factors
Other conditions that made the incident more likely or more severe.
Root cause(s)
The underlying system or management factor. Use the "5 Whys": ask why the immediate cause existed, then why that existed, until you reach something the organization controls (missing procedure, no training, no inspection, production pressure).
Primary root-cause category
Has this or a similar incident happened before?
A repeat event means a prior corrective action failed or was never closed out.
Corrective Actions
6 checksImmediate / interim actions already taken
What was done right away to make the area safe — barricade, shutdown, cleanup, first aid.
Corrective action(s) to prevent recurrence
Address the root cause, not just the immediate cause.
Highest level of control in the corrective action
Hierarchy of controls, most to least effective.
Person responsible for corrective actions
A named owner. "The team" does not get it done.
Target completion date
Corrective action status
Evidence
3 checksPhoto of the scene or area
Photograph the scene before it is cleaned up or disturbed, if it is safe to do so.
Photo of equipment, material, or hazard involved
Other evidence collected or reference numbers
e.g., maintenance logs, training records, CCTV reference, workers' comp claim number.
Review & Sign-off
4 checksInvestigator signature
Reviewed by (supervisor or manager name and title)
Management review signature
Date reviewed
Yours to edit
Match the form to your investigation process.
Clone the template and open it in the builder. Add fields for your internal incident numbering, insurance or workers' comp claim references, or site-specific causal categories. The core investigation structure stays intact. You extend it for your workflow.
Field procedure
How to run this inspection
Begin the investigation as soon as possible after the incident, ideally at the scene before conditions change. Stick to facts in the early sections; save analysis of why for the Causal Analysis section.
STEP 01
Classify and capture the basics
Open the report at the scene. Select the incident classification (near-miss, first aid, recordable injury, property damage, environmental release) and the potential severity if it happened again. Judge the realistic worst case, not just what happened this time. Record the date, time, exact location, department, task being performed, and equipment or materials involved.
STEP 02
Document persons involved
Record the affected person's name, relationship to the company, job title, and time in that role. Newer workers are over-represented in incidents and that context matters for root cause. If the person was injured, complete the injury section: nature of injury, body part affected, the object or substance that caused the harm, and the medical outcome. Note whether OSHA recordability is likely.
STEP 03
Interview witnesses promptly
Interview witnesses separately and soon after the incident, while memories are fresh. Record names and capture facts, not opinions about fault. Document the sequence of events leading up to the incident. Reconstruct the chain in order, including conditions at the time: lighting, weather, housekeeping, time pressure, and anything unusual.
STEP 04
Identify root causes
Separate the immediate cause (the unsafe condition or action present at the moment) from the contributing factors and the root cause (the underlying system or management factor). Use the 5-Whys: ask why the immediate cause existed, then why that existed, until you reach something the organization controls: a missing procedure, no training, no inspection, or production pressure. Select the primary root-cause category.
STEP 05
Document corrective actions and sign off
Record the immediate interim actions already taken to make the area safe. Document corrective actions to prevent recurrence. Prefer elimination and engineering controls over administrative controls and PPE. Assign a named owner and a target completion date. Photograph the scene and any equipment involved before cleanup. Get the investigator signature and management review.
FAQ
Common questions
Is this incident report template free?+
Does this replace the OSHA Form 301?+
Should we investigate near-misses the same way as actual injuries?+
What is the difference between an immediate cause and a root cause?+
Does this work offline at a remote worksite?+
When does OSHA require the report to be completed?+
Document your next incident from the scene
Open the template at the worksite, capture facts, photos, and witness accounts while the scene is fresh, and close with dual signatures. You'll have a complete investigation record (OSHA 301 data included) ready to file before the shift ends.