Warehouse Incident Report Form

Use the Warehouse Incident Report Form to document and report incidents and injuries, ensuring swift response and compliance with safety regulations.

Download as free PDF

Library
Logistics & Supply Chain
Warehouse Incident Report Form

General

Injury Details

Damage

Vehicle Damage

Analysis

Is this sample what you are looking for?
Sign up to use & customise this template, or create your own custom checklist:

Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

Easy inspection app for your digital checklists

Conduct inspections anytime, anywhere - even offline
Capture photos as proof of compliance or areas needing attention
Instantly generate and share detailed reports after the inspections
Assign & track follow-up tasks, view historical trends on a centralized dashboard

Warehouse Incident Report Form

Use the Warehouse Incident Report Form to document and report incidents and injuries, ensuring swift response and compliance with safety regulations.

1. Name

2. Please specify the date and time of the incident:

3. Please specify the date and time the incident was reported:

4. Who was the incident reported to?

5. Please specify the exact location of incident:

6. Were there any witnesses?

7. Provide names of witnesses:

1. Please describe the injuries sustained:

2. Was any first-aid or medical treatment provided? Write down more details on this in Comments.

1. Was there any damage to property?

2. what is the extent of damage?

3. Please provide a picture of the damage:

1. Please provide a picture of the damage to the vehicle:

2. Vehicle ID

3. Please provide a detailed description of the incident – include ambient conditions, distractions, or any other note-worthy points

4. Please provide a picture of the environment after the incident.

5. What directly caused the incident?

6. Please provide a photo of this cause.

1. What were the contributing factors that caused the incident?

2. Please provide a picture of the contributing factors:

3. Please suggest corrective actions to be taken:

4. Please assign a person to ensure corrective actions are acted upon:

5. Could the incident have been severe than it was?

6. Is there a possibility for reoccurrence of such incidents?