Requests & intake

Incident report form template

Date, location, people involved, description, injuries or damage, witnesses and immediate actions, for workplaces and venues.

8 questions · about 5 minutes to complete · free on every plan

Free account required. The template is copied into your workspace; edit anything before publishing.

When to use it: As soon as possible after an incident.
Who it is for: Staff reporting an incident.

How to use this template

Use a dropdown for the request type so routing is clean.
Ask for the preferred contact method.
Send submissions to your inbox or helpdesk with a webhook.

Questions in the incident report form template

1. Reported by
contact info
2. Date of incident
date
3. Time and location
open text
4. Type
single choice · Injury, Near miss, Property damage, Security, Other
5. What happened?
open text
6. Was anyone injured?
single choice · No, Yes — first aid, Yes — medical treatment, Yes — emergency services
7. Witnesses (names and contact)
open text
8. Immediate actions taken
open text

What the results look like

IllustrativeSynthetic sample of 120 responses generated for this preview, not real survey data. Your results page shows the same charts for your own responses.

1.Type

120 answered

Answer distribution
Answer	Count	Percent
Injury	23	19%
Near miss	15	13%
Property damage	18	15%
Security	13	11%
Other	51	43%

2.Was anyone injured?

120 answered

Answer distribution
Answer	Count	Percent
No	52	43%
Yes — first aid	13	11%
Yes — medical treatment	31	26%
Yes — emergency services	24	20%

How to read these questions

single choice: Read the share choosing each option, then cross-tab by a segment question to see who differs.

Frequently asked questions

Can form submissions be sent to my email or another tool?

Yes. Webhooks and the API deliver each submission in real time; email notifications are available through your automation tool.

How long does the incident report form take to complete?

About 5 minutes: 8 questions, most of them single-tap. Every question can be edited, removed or reordered in the builder before you publish.

Is this template free to use?

Yes. Every template is included on the Free plan. Sign up, click Use this template, and it is copied into your workspace where you can edit it, add your logo and share it by link, email or embed.