Get the free Incident Statement Form

This form is intended for employees and witnesses to describe events related to an incident, including details such as who was involved, what happened, when and where it occurred, and why it is significant. It assists in gathering relevant information for investigations.

How to fill out incident statement form

How to fill out incident statement form

1. Begin by providing your personal information, including your name, contact details, and position.
2. State the date, time, and location of the incident clearly.
3. Describe the nature of the incident in detail, including what happened and any contributing factors.
4. List any individuals involved or witnesses to the incident, including their contact information if available.
5. Include any actions taken in response to the incident immediately after it occurred.
6. Attach any relevant documents or evidence, such as photographs or witness statements.
7. Review your statement for clarity and accuracy before submitting.

Who needs incident statement form?

1. Individuals involved in an incident who need to document the events.
2. Employees who require a record for workplace safety and compliance.
3. Human Resources or management who need to investigate incidents.
4. Insurance companies that may require documentation for claims.
5. Legal professionals who need evidence for any potential legal matters.

For pdfFiller’s FAQs

Can I sign the incident statement form electronically in Chrome?

Yes, you can. With pdfFiller, you not only get a feature-rich PDF editor and fillable form builder but a powerful e-signature solution that you can add directly to your Chrome browser. Using our extension, you can create your legally-binding eSignature by typing, drawing, or capturing a photo of your signature using your webcam. Choose whichever method you prefer and eSign your incident statement form in minutes.

Can I create an electronic signature for signing my incident statement form in Gmail?

Upload, type, or draw a signature in Gmail with the help of pdfFiller’s add-on. pdfFiller enables you to eSign your incident statement form and other documents right in your inbox. Register your account in order to save signed documents and your personal signatures.

Can I edit incident statement form on an iOS device?

Use the pdfFiller mobile app to create, edit, and share incident statement form from your iOS device. Install it from the Apple Store in seconds. You can benefit from a free trial and choose a subscription that suits your needs.

What is incident statement form?

An incident statement form is a document used to report and document details of an incident, event, or accident, providing a formal record for review and analysis.

Who is required to file incident statement form?

Typically, individuals who witness or are involved in an incident are required to file an incident statement form, including employees, supervisors, and sometimes third-party witnesses.

How to fill out incident statement form?

To fill out the incident statement form, start by providing basic information such as date, time, and location of the incident, followed by a detailed description of what occurred, including the people involved and any actions taken.

What is the purpose of incident statement form?

The purpose of the incident statement form is to create an official record of incidents for safety investigations, compliance reporting, and to improve future safety practices.

What information must be reported on incident statement form?

The information that must be reported on the incident statement form typically includes the date and time of the incident, location, names of individuals involved, a detailed description of the incident, and any witnesses or follow-up actions taken.