Accident report form for a workplace

Updated 2026-10-30

After an accident the facts fade fast and the story changes in the retelling. I want the date, the place, who was hurt and what was done, written down while it is fresh. This accident report form keeps that record in one place.

Before anything happens

Share the link where staff will find it, such as the staff room and the shared drive. Check your local privacy rules before collecting health data. This is a form, not legal advice and not medical advice. Have a professional check wording that has legal weight.

When it happens

Look after the person first, then report. The form asks who was hurt, their role, when and where, what happened, the kind of injury and what care was given. Witness names and any hazard still there come last. Keep the words plain. A reporter's AI might ask: "Where did it happen?" Then "What happened, in your own words?" Then "Was first aid given?" It shows the answers and sends only after a yes. Read about agent-fillable forms.

After it is reported

Read the hazard tick first. Fix the cause, then act on the answer to what would stop it happening again. Keep medical details in your own protected system. Costs after an accident, such as a taxi to a clinic, can go through an expense report template. Hurt on a work trip? The earlier travel request form shows where the person was meant to be. Browse forms for HR and recruiting and forms for IT and operations. A workplace incident report works the same way.

Questions

Is the report enough for insurance or the authorities?

Not on its own, and rules differ by place. Ask your insurer or a professional what they need, then add those questions to the form.

Why does the form not ask for a diagnosis?

It needs plain words on what happened, not a diagnosis. First aid and follow-up are the facts you must act on. Keep medical records in your own protected system.

Who should fill it in?

Anyone who saw it, or the person hurt if they are able. A witness can give the form to their own AI agent, which shows all answers before anything is sent.

Try the form

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Report an accident or near miss

Look after anyone who is hurt first. Then tell us what happened in plain words. No diagnosis is needed.

Write none if nobody was hurt.

Their role
What kind of injury was it?
What care was given?
The hazard is still there
A manager has been told
Use this templateAll templates

Or paste the JSON

Give this to your AI. It needs the AI Form API MCP server or an API key. It makes the form and sends you the link.

text
Create this form with the AI Form API create_form tool (or POST https://aiformapi.com/v1/forms with my API key). Then reply with the public_url.

{
  "title": "Report an accident or near miss",
  "description": "Look after anyone who is hurt first. Then tell us what happened in plain words. No diagnosis is needed.",
  "fields": [
    {
      "id": "reporter_name",
      "label": "Your name",
      "type": "short_text",
      "required": true,
      "max_length": 150
    },
    {
      "id": "injured_person",
      "label": "Name of the person who was hurt",
      "type": "short_text",
      "required": true,
      "help": "Write none if nobody was hurt.",
      "max_length": 150
    },
    {
      "id": "injured_role",
      "label": "Their role",
      "type": "single_choice",
      "options": [
        "Employee",
        "Contractor",
        "Visitor",
        "Customer"
      ]
    },
    {
      "id": "incident_date",
      "label": "Date it happened",
      "type": "date",
      "required": true
    },
    {
      "id": "incident_time",
      "label": "Approximate time",
      "type": "short_text",
      "max_length": 50
    },
    {
      "id": "incident_place",
      "label": "Where did it happen?",
      "type": "short_text",
      "required": true,
      "max_length": 300
    },
    {
      "id": "what_happened",
      "label": "What happened, in your own words?",
      "type": "long_text",
      "required": true,
      "max_length": 3000
    },
    {
      "id": "injury_kind",
      "label": "What kind of injury was it?",
      "type": "multi_choice",
      "options": [
        "Cut or graze",
        "Bruise",
        "Sprain or strain",
        "Burn",
        "Fall",
        "Eye injury",
        "Other",
        "No injury, near miss"
      ]
    },
    {
      "id": "care_given",
      "label": "What care was given?",
      "type": "single_choice",
      "options": [
        "None needed",
        "First aid on site",
        "Emergency services called",
        "Went to a clinic or hospital"
      ]
    },
    {
      "id": "witnesses",
      "label": "Names of any witnesses",
      "type": "long_text",
      "max_length": 800
    },
    {
      "id": "hazard_remains",
      "label": "The hazard is still there",
      "type": "checkbox"
    },
    {
      "id": "prevent_repeat",
      "label": "What would stop this happening again?",
      "type": "long_text",
      "max_length": 1500
    },
    {
      "id": "manager_informed",
      "label": "A manager has been told",
      "type": "checkbox"
    }
  ]
}

Or call the API

bash
curl -X POST https://aiformapi.com/v1/forms \
  -H "Authorization: Bearer $AIFORMAPI_KEY" \
  -H "Content-Type: application/json" \
  -d '{"title":"Report an accident or near miss","description":"Look after anyone who is hurt first. Then tell us what happened in plain words. No diagnosis is needed.","fields":[{"id":"reporter_name","label":"Your name","type":"short_text","required":true,"max_length":150},{"id":"injured_person","label":"Name of the person who was hurt","type":"short_text","required":true,"help":"Write none if nobody was hurt.","max_length":150},{"id":"injured_role","label":"Their role","type":"single_choice","options":["Employee","Contractor","Visitor","Customer"]},{"id":"incident_date","label":"Date it happened","type":"date","required":true},{"id":"incident_time","label":"Approximate time","type":"short_text","max_length":50},{"id":"incident_place","label":"Where did it happen?","type":"short_text","required":true,"max_length":300},{"id":"what_happened","label":"What happened, in your own words?","type":"long_text","required":true,"max_length":3000},{"id":"injury_kind","label":"What kind of injury was it?","type":"multi_choice","options":["Cut or graze","Bruise","Sprain or strain","Burn","Fall","Eye injury","Other","No injury, near miss"]},{"id":"care_given","label":"What care was given?","type":"single_choice","options":["None needed","First aid on site","Emergency services called","Went to a clinic or hospital"]},{"id":"witnesses","label":"Names of any witnesses","type":"long_text","max_length":800},{"id":"hazard_remains","label":"The hazard is still there","type":"checkbox"},{"id":"prevent_repeat","label":"What would stop this happening again?","type":"long_text","max_length":1500},{"id":"manager_informed","label":"A manager has been told","type":"checkbox"}]}'

JSON definition

json
{
  "title": "Report an accident or near miss",
  "description": "Look after anyone who is hurt first. Then tell us what happened in plain words. No diagnosis is needed.",
  "fields": [
    {
      "id": "reporter_name",
      "label": "Your name",
      "type": "short_text",
      "required": true,
      "max_length": 150
    },
    {
      "id": "injured_person",
      "label": "Name of the person who was hurt",
      "type": "short_text",
      "required": true,
      "help": "Write none if nobody was hurt.",
      "max_length": 150
    },
    {
      "id": "injured_role",
      "label": "Their role",
      "type": "single_choice",
      "options": [
        "Employee",
        "Contractor",
        "Visitor",
        "Customer"
      ]
    },
    {
      "id": "incident_date",
      "label": "Date it happened",
      "type": "date",
      "required": true
    },
    {
      "id": "incident_time",
      "label": "Approximate time",
      "type": "short_text",
      "max_length": 50
    },
    {
      "id": "incident_place",
      "label": "Where did it happen?",
      "type": "short_text",
      "required": true,
      "max_length": 300
    },
    {
      "id": "what_happened",
      "label": "What happened, in your own words?",
      "type": "long_text",
      "required": true,
      "max_length": 3000
    },
    {
      "id": "injury_kind",
      "label": "What kind of injury was it?",
      "type": "multi_choice",
      "options": [
        "Cut or graze",
        "Bruise",
        "Sprain or strain",
        "Burn",
        "Fall",
        "Eye injury",
        "Other",
        "No injury, near miss"
      ]
    },
    {
      "id": "care_given",
      "label": "What care was given?",
      "type": "single_choice",
      "options": [
        "None needed",
        "First aid on site",
        "Emergency services called",
        "Went to a clinic or hospital"
      ]
    },
    {
      "id": "witnesses",
      "label": "Names of any witnesses",
      "type": "long_text",
      "max_length": 800
    },
    {
      "id": "hazard_remains",
      "label": "The hazard is still there",
      "type": "checkbox"
    },
    {
      "id": "prevent_repeat",
      "label": "What would stop this happening again?",
      "type": "long_text",
      "max_length": 1500
    },
    {
      "id": "manager_informed",
      "label": "A manager has been told",
      "type": "checkbox"
    }
  ]
}