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Accident Report · Popular

Construction Site Worker Injury & Accident Report Form

Capture detailed construction site injury data, root cause analysis, and worker information with this ready-to-use accident investigation form.

Use This Template Free Preview

Volt theme

formbuilder.ai/f/construction-site-worker-injury-accident-investigation-report-form

Construction Site Worker Injury & Accident Investigation Report Form

Report/Case Number

· · ·

Date of Incident

· · ·

Time of Incident

· · ·

Submit

The Construction Site Worker Injury & Accident Investigation Report Form is a comprehensive tool designed to help safety managers, site supervisors, and project managers document workplace incidents quickly and accurately. It captures everything from incident location and weather conditions to injured worker details, injury severity, and root cause analysis in one structured form.

This template is ideal for general contractors, subcontractors, construction companies, and safety officers who need to comply with OSHA reporting requirements and maintain thorough records of on-site accidents. By standardizing the data collection process, it reduces errors and ensures no critical details are missed during an investigation.

Using this form helps organizations identify hazard patterns, prevent future incidents, and demonstrate due diligence in maintaining a safe work environment. Get started in minutes — customize the template to match your project's specific safety protocols and deploy it across all your job sites instantly.

4 Pages

33 Questions

~11min To complete

Free No credit card needed

Field types Short Text ×7 Long Text ×6 Date ×3 Dropdown ×3 Single Choice ×3 Full Name ×2 Multiple Choice ×2 Time Picker Address Phone number File Upload termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Incident Overview 7 questions

Incident Overview

1 Report/Case Number * Short Text

2 Date of Incident * Date

3 Time of Incident * Time Picker

4 Project Name / Job Site Name * Short Text

5 Incident Location (Full Site Address) * Address

6 Exact Location on Site (e.g., 3rd floor scaffolding, excavation trench B) * Long Text

7 Weather Conditions at Time of Incident * Dropdown

Page 2 Injured Worker Details 10 questions

Injured Worker Information

1 Injured Worker's Full Name * Full Name

2 Worker's Phone Number * Phone

3 Job Title / Trade * Short Text

4 Employer / Subcontractor Company Name * Short Text

5 Years of Experience in Current Role number

6 Type of Injury * Dropdown

7 Body Part(s) Affected * Multiple Choice

8 Severity of Injury * Dropdown

9 Was the worker transported to a medical facility? * Single Choice

10 Name of Hospital/Medical Facility (if applicable) Short Text

Page 3 Incident Description & Investigation 7 questions

Incident Description & Root Cause Analysis

1 Detailed Description of How the Incident Occurred * Long Text

2 Contributing Factors (select all that apply) * Multiple Choice

3 Describe Root Cause(s) of the Incident * Long Text

4 Were proper safety procedures being followed at the time? * Single Choice

5 Was the worker wearing required PPE at the time of the incident? * Single Choice

6 Witness Statement(s) — Include names and accounts Long Text

7 Upload Photos, Videos, or Supporting Documents (incident scene, equipment, injuries) File Upload

Page 4 Corrective Actions & Sign-Off 9 questions

Corrective Actions & Recommendations

1 Immediate Corrective Actions Taken * Long Text

2 Recommended Preventive Measures to Avoid Recurrence * Long Text

3 Target Date for Corrective Action Completion * Date

4 Person Responsible for Follow-Up Actions * Short Text

Report Completed By

5 Investigator / Safety Officer Name * Full Name

6 Title / Role * Short Text

7 Date of Report Completion * Date

8 I certify that the information provided in this report is accurate and complete to the best of my knowledge. * termsandconditions

9 Investigator / Safety Officer Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.