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Incident Report Form

An incident report form is a quick first-report document that any employee fills in as soon as possible after an unusual event at work, such as an injury, near miss, property damage, security breach or argument. It captures the basic facts while memory is fresh so the right team can follow up.

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[Company Logo][Company Name]

INCIDENT REPORT FORM

Report No.:: [Reference Number]
Site:: [Work Location]
Date of Report:: [Date]

Reported By

Name
Employee ID
Designation / Department
Contact Number

Type of Incident

Injury or illness
Near miss
Property damage
Loss or theft
Security breach
Verbal or physical altercation
Other

Incident Details

Date of incident
Time
Exact location
What happened (facts only)
Persons involved (name, ID)
Witnesses (name, ID)

Injury / Damage

Was anyone injured? Nature of injury
First aid given by
Taken to hospital / clinic (name)
Property or equipment damaged

Immediate Action

Action taken immediately
Area made safe? (Yes/No)
CCTV preserved? (Yes/No)

I confirm the information above is accurate to the best of my knowledge. I understand that reporting an incident in good faith will not lead to any unfavourable treatment.

Reporter
[Name]
Date: [Date]

Supervisor
[Name]
Date: [Date]

Follow-up (HR / Safety)

Forwarded to
Investigation required? (Yes/No)
Corrective action
Closed on

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What this template includes

Incident type tick-boxes
Date, time and exact location
Short factual description
People involved and witnesses
Injury or damage details
Immediate action taken, such as first aid
Reporter signature and supervisor review

When to use it

An employee slips, cuts a hand or feels unwell at work
A near miss happens, such as a falling object or forklift close call
Company property is damaged, lost or stolen
A verbal altercation or security breach takes place on premises

How to customise this template

1Keep it to one page so it is filled in quickly
2Place printed copies at security, the first-aid room and each floor
3Add your first-aid and emergency contact numbers
4Route safety incidents to the safety officer and conduct incidents to HR
5Number the forms for tracking

HR tips

Report immediately or within the same shift
Stick to facts; leave blame and causes to the follow-up investigation
Preserve CCTV and the scene where possible
Never penalise employees for reporting near misses

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Frequently asked questions

What is an incident report form?+

A first-report form employees use to record an unusual workplace event such as an injury, near miss, damage or altercation.

Who should fill in the incident report?+

The person involved or the first person who saw it. A supervisor then reviews and signs it.

What happens after an incident report is filed?+

The supervisor, HR or safety team reviews it, takes corrective steps and may open an investigation.

All 50 employee relations & grievances →

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Workplace Incident Report
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[Company Logo][Company Name]
EMPLOYEE GRIEVANCE FORM
Company:
[Company Name]
Grievance Case No.:
[Reference Number]
Date of Submission:
[Date]
Use this form to formally raise a work-related grievance. Please write clearly and attach any supporting documents. Complaints of sexual harassment must be submitted to the Internal Committee under the company's POSH policy and not on this form.
Section A: Employee Details
Employee Name
Employee ID
Designation
Department
Work Location
Reporting Manager
Mobile Number
Official Email
Section B: Nature of Grievance
- Salary, wages, overtime or deductions
- Leave or attendance
- Working conditions, shift or safety
- Transfer, promotion or appraisal
- Interpersonal issue with a colleague or manager
- Application of a company policy
- Other (please specify)
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Employee Grievance Form
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[Company Logo][Company Name]
EMPLOYEE COMPLAINT FORM
Company:
[Company Name]
Complaint No.:
[Reference Number]
Date:
[Date]
This form is used to report conduct that you believe breaches company rules or the code of conduct. All complaints are treated confidentially. If your complaint relates to sexual harassment, please approach the Internal Committee directly as per the company's POSH policy.
1. Complainant Details
Employee Name
Employee ID
Designation
Department
Work Location
Contact Number
Preferred mode of contact
2. Person(s) Complained Against
Name
Designation / Role
Department or Organisation (if vendor/customer)
Relationship to you (colleague, supervisor, vendor, other)
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Employee Complaint Form
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[Company Logo][Company Name]
GRIEVANCE INVESTIGATION FORM
Case No.:
[Reference Number]
Date Opened:
[Date]
Classification:
Strictly Confidential
Part 1: Case Details
Complainant [Employee Name], [Employee ID], [Department]
Respondent (if any): Name, Designation, Department
Date grievance received
Grievance category
Part 2: Terms of Reference
Issue 1 to be investigated
Issue 2 to be investigated
Issue 3 to be investigated
Matters outside scope (if any)
Target completion date
Part 3: Investigator Appointment and Independence
Form · Word
Grievance Investigation Form
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[Company Logo][Company Name]
GRIEVANCE INVESTIGATION REPORT
Case No.:
[Reference Number]
Report Date:
[Date]
Prepared by:
[Investigator Name], [Designation]
Submitted to:
[Decision Maker Name]
Classification:
Strictly Confidential
1. Executive Summary
This report sets out the investigation into the grievance raised by [Employee Name], [Designation], on [Date]. Of the [Number] issues investigated, [Number] were substantiated, [Number] were not substantiated and [Number] were inconclusive.
2. Background and Terms of Reference
[Brief neutral description of the grievance.] The investigator was appointed on [Date] by [Name] to examine: (a) [Issue 1]; (b) [Issue 2]; (c) [Issue 3].
3. Methodology
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Grievance Investigation Report
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[Company Logo][Company Name]
WORKPLACE COMPLAINT FORM
Site / Unit:
[Work Location]
Form No.:
[Reference Number]
Date:
[Date]
Anyone working at this site may use this form. You may give your name or leave it blank. For complaints of sexual harassment please contact the Internal Committee: [IC Presiding Officer Name], [Phone].
About You (optional)
Name
Employee ID / Gate Pass No.
Category: Employee / Contract Worker / Trainee / Apprentice
Contractor Company (if applicable)
Department / Line
Shift
Contact Number
Type of Complaint
- Safety hazard or unsafe practice
- Washroom, drinking water or hygiene
- Canteen or food quality
- Transport or shuttle
- Wages, overtime or deductions
- Behaviour of a person
- Equipment, PPE or tools
- Other
Form · Word
Workplace Complaint Form
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[Company Logo][Company Name]
WORKPLACE CONFLICT FORM
Company:
[Company Name]
Form No.:
[Reference Number]
Date:
[Date]
1. Submitted By
Name [Employee Name]
Employee ID [Employee ID]
Designation / Department
Submitting as: Party to the conflict / Manager / Other
2. Parties Involved
Name Designation Department Working Relationship
[Employee Name] [Designation] [Department] [Peer / Reports to / Cross-team]
[Employee Name] [Designation] [Department] [Relationship]
3. Nature of Conflict
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Workplace Conflict Form
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[Company Logo][Company Name]
CONFLICT RESOLUTION FORM
Ref. No.:
[Reference Number]
Meeting Date:
[Date]
Facilitator:
[Facilitator Name], [Designation]
Parties
Party A [Employee Name], [Designation], [Department]
Party B [Employee Name], [Designation], [Department]
Issues Discussed
1. [Issue 1, e.g., allocation of client follow-ups]
2. [Issue 2, e.g., tone in team chat]
3. [Issue 3]
Agreed Commitments
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Conflict Resolution Form
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Date and time
Location
Type of incident
Brief summary

Time	Event	Source
[Time]	[Event]	[Witness / CCTV / Log]
[Time]	[Event]	[Source]
[Time]	[Event]	[Source]