Free Safety Incident Log Template
Safety Incident Log
This Safety Incident Log is designed to record and track safety incidents within an organization. The purpose of this log is to ensure that all incidents are documented, reviewed, and analyzed to improve workplace safety and prevent future occurrences. Accurate and thorough logging of safety incidents is crucial for maintaining a safe working environment and complying with regulatory requirements.
Incident Details
|
Incident ID |
Date |
Time |
Location |
Incident Type |
Description |
Immediate Actions |
|---|---|---|---|---|---|---|
|
001 |
2050-08-20 |
09:30 AM |
Warehouse A |
Slip and Fall |
Employee slipped on wet floor, resulting in a minor ankle injury. |
Applied first aid, cleaned the spill. |
Injured Personnel
|
Incident ID |
Name |
Department |
Injury Details |
Treatment Provided |
Status |
|---|---|---|---|---|---|
|
001 |
John Doe |
Warehouse |
Minor ankle sprain |
First aid, ice pack |
Returned to work |
Investigation Details
|
Incident ID |
Investigator Name |
Investigation Date |
Findings |
Root Cause Analysis |
Recommendations |
|---|---|---|---|---|---|
|
001 |
Alice Green |
2050-08-20 |
Floor was wet due to a leaking pipe. |
Poor maintenance of floor area. |
Repair pipe, increase maintenance checks. |
Corrective Actions
|
Incident ID |
Action Description |
Responsible Person |
Completion Date |
Status |
|---|---|---|---|---|
|
001 |
Repair the leaking pipe and clean floor area. |
Maintenance Team |
2050-08-22 |
Completed |
Incident Review
|
Incident ID |
Review Date |
Reviewed By |
Review Summary |
|---|---|---|---|
|
001 |
2050-08-23 |
Laura Mitchell |
Incident handled appropriately; corrective actions were effective. |
Incident Analysis
|
Month |
Total Incidents |
Major Incident Types |
Recommendations for Improvement |
|---|---|---|---|
|
August |
3 |
Slip and Fall, Equipment Failure, Chemical Spill |
Increase training, improve equipment maintenance, enhance spill response procedures. |
