Safety Forms
Incident Investigation Form
A 3-page Incident Investigation Form that goes past 'what happened' into root cause - Unsafe Practices, Unsafe Conditions, Job Factors, and Personal Factors checkbox grids, an Action Items table with owners and due dates, and a full Witness Statement page - delivered as a real fillable PDF.
- Fillable PDF — type into it on any device, or print it blank
- 3 pages, 8.5" x 11" (Letter)
- Add your company logo at checkout — no extra charge
- Written by Canadian safety professionals to provincial OHS standards
- Instant download after purchase
Written by certified COR auditors · Trusted by Canadian contractors for 17+ years · Secure Stripe checkout · Instant delivery + re-download any time from your purchases page
Pairs with online training
Certificates issue instantly through our online training portal.
58 CAUSE-ANALYSIS CHECKBOXES ACROSS DIRECT, JOB, AND PERSONAL FACTORS, PLUS A WITNESS STATEMENT PAGE
What you get
- A fillable PDF - check boxes and type directly into all 3 pages
- Page 1: Incident Specifics (type, date, time, location), Injury/Illness details, Property Damage details, and a Description of Incident section
- Page 2: a Diagram area, a 4-quadrant Cause Analysis grid (Unsafe Practices, Unsafe Conditions, Job Factors, Personal Factors - 58 checkboxes total plus 'Other' lines), a 4-row Action Items table with Assigned To / Due Date / Completion Date, and an Investigated By / Follow-up Review / Management Signature sign-off
- Page 3: a full Witness Statement page (contact details, employment details, an 11-line description area, and signature)
- Your company logo added to the form, at no extra charge
How to fill it out and keep it. Open it in Adobe Acrobat Reader (free) or a desktop browser like Chrome or Edge, then use that program's own Save or Download button, not just closing the tab, so your entries are kept in the saved copy. On a phone, most PDF apps will let you view the form but not type into it - fill it out on a computer, or print it and use a pen.
Specifications
- Size
- 8.5" x 11" (Letter), 3 pages
- Format
- Fillable PDF - type into it on any device, or print it blank
- Company logo
- Included - upload at checkout, or we print your company name instead
- Delivery
- Instant download after purchase
Why crews use it
- Separating Unsafe Practices and Unsafe Conditions from Job Factors and Personal Factors follows a recognized root-cause framework, not just a list of what went wrong on the surface
- 58 specific cause-analysis checkboxes mean an investigation doesn't stop at 'worker error' - it forces a look at training, supervision, equipment, and workload factors behind the immediate cause
- An Action Items table with a named owner and due date turns investigation findings into tracked corrective action, not just a report that gets filed away
- A built-in Witness Statement page means witness accounts are captured on the same standardized document as the investigation itself, in a format ready for COR/SECOR or WCB review
Built for
- Safety coordinators and supervisors investigating workplace incidents, injuries, near misses, or property damage
- Companies needing WCB-compliant, COR/SECOR-ready incident investigation documentation with genuine root-cause analysis
- HSE managers standardizing how incidents are investigated and how corrective actions are tracked to completion across the organization
Why it matters
An investigation that only records what happened - without asking why the unsafe condition existed or what job or personal factor contributed to it - tends to repeat itself. Working through Unsafe Practices, Unsafe Conditions, Job Factors, and Personal Factors on every incident is what surfaces the systemic issue behind an event, not just the worker closest to it when it happened.
Try it right here
Click a box. Type a line. See how it feels before you buy.
This is the real form layout - what you type here isn't saved or sent anywhere, it's just so you can see the fields work before you pay.
Common questions
Before you buy
What people ask us about the Incident Investigation Form.
What is the Incident Investigation Form used for?
Incident Investigation Form - Custom Logo PDF Download Document workplace incidents thoroughly and compliantly with a professionally designed, branded investigation form. The Incident Investigation Form provides a structured format for recording the who, what, when, where, and how of any workplace incident - including injuries, near misses, property damage, and dangerous occurrences. A thorough, well-documented investigation is required by OHS legislation and is critical for identifying root causes, implementing corrective actions, and preventing recurrence. Each form is customised with your company logo and name, then emailed to you as a ready-to-print PDF. Upload your logo at checkout or supply your company name for text-only branding. Product Specifications: Size: 8.5" x 11" (Letter) Delivered as a print-ready PDF Custom company logo or name Ready to print and use immediately Built For: Canadian employers, safety coordinators, supervisors, and HSE managers who need a professional, consistent incident documentation process. Supports COR/SECOR audit evidence requirements, WCB reporting requirements, and OHS compliance across all Canadian provinces and industries. It is written for Canadian workplaces and formatted so it can go straight into your safety program.
Is it editable, or print-ready only?
It is supplied print-ready. If you need it adapted to your own program wording, we can do that as part of a manual build.
Does using this form make us compliant?
No single form makes a company compliant. A form is the evidence half of a safety program - it records that something was checked and by whom. It carries weight at audit time when the written program behind it says the check is required and how often. If that program does not exist yet, that is the part we write.
What format is it, and when do I get it?
It is a digital download available immediately after checkout, and you can print as many copies as your own crews need.
From the team that wrote it
These forms come from a bigger program.
Inspection and competency forms are the evidence half of a safety program. If the program they belong to does not exist yet, or has not been updated in a few years, that is the part we write.