Construction Incident Report

Free Construction Incident Report Template. Fill it out in your browser, print to PDF, or save the file and use it offline. No email required. Want incidents captured automatically from a voice report and auto-classified for OSHA? Try Plan of Day.

Disclaimer. This template covers the fields OSHA typically requires on incident reports. It is not legal advice. Verify state OSHA plan, insurance carrier, and employer-specific requirements before filing. For fatalities, hospitalizations, amputations, and loss of eye, federal OSHA reporting deadlines apply (29 CFR 1904.39).

1 · Incident Identification

Report / Incident #

Date of Incident

Time of Incident (24hr)

Date Reported

Project Name

Project #

Site Address

Specific Location on Site (area, elevation, grid, room)

2 · Company Information

Employer Name

Employer Address

Phone

Federal ID # / EIN

Worker's Comp Carrier

Policy #

3 · Person Involved

Full Name

Job Title / Trade

Date of Birth

Date of Hire

Supervisor at Time of Incident

Home Address

Phone

4 · Incident Classification

OSHA Reporting Triggers: Fatality — report within 8 hours. Hospitalization, amputation, or loss of eye — report within 24 hours. Call 1-800-321-OSHA or file online at osha.gov. (29 CFR 1904.39)

First aid only

Medical treatment required

Restricted duty / days away

Hospitalization (24-hr OSHA)

Amputation (24-hr OSHA)

Loss of eye (24-hr OSHA)

Fatality (8-hr OSHA)

Near miss / unsafe condition (no injury)

6 · Medical Treatment

First Aid Provided On Site (describe)

Treated at Hospital / Clinic (name and address)

Treating Physician

Date of First Treatment

Expected Return-to-Work Date

8 · Witnesses

Name	Company	Phone	Role at Incident

9 · Description of Incident

What happened — sequence of events, in the order they occurred

10 · Root Cause Analysis (5-Why or Equivalent)

Immediate Cause (what directly caused the incident)

Contributing Factors (conditions, actions, environment)

Root Cause (underlying system or process failure)

Similar Incidents on This Project?

If Yes, Describe

11 · Corrective Actions

Action	Responsible Party	Target Date	Verification Method

12 · OSHA Reporting

OSHA Recordable?

OSHA 300 Log Entry #

OSHA 301 Form Filed?

301 Date Filed

8-hr / 24-hr OSHA Notification Made?

Notification Date / Time

OSHA Contact / Office / Reference #

Forms Filed with State OSHA Plan / Insurance / Other Agencies

13 · Photographs & Documentation

Photos Taken (describe subjects and file references)

Other Documentation Attached (witness statements, medical records, equipment logs, training records)

14 · Signatures

Prepared By — Name, Title, Date

Reviewed By Safety Manager — Date

Approved By Project Manager — Date

1 · Incident Identification

2 · Company Information

3 · Person Involved

4 · Incident Classification

5 · Injury Details

6 · Medical Treatment

7 · Equipment / Materials Involved

8 · Witnesses

9 · Description of Incident

10 · Root Cause Analysis (5-Why or Equivalent)

11 · Corrective Actions

12 · OSHA Reporting

13 · Photographs & Documentation

14 · Signatures