= Required Fields

Online Form - Accident/Incident Report

Personal Details


Accident/Incident


Full Accident/Incident Details

What happened or in the case of a near miss, what could have happened?

Near Miss

Injury Details

Was anyone injured?

If Yes, complete the Questions below, If No, go to Damage to equipment/buildings/vehicles.

Nature of Injury




Location of Injury





Result of Accident

Lost Time Injury
Workers Compensation
Treatment Received

Damage to equipment/buildings/vehicles etc.

Was any property damaged?

If Yes, complete the Questions below, If No, go to Contributing Factors.


Contributing Factors


Corrective Actions