Workplace Incident Report Form
This comprehensive workplace incident report form helps organizations document and investigate safety incidents effectively. Capture incident details, involved parties, witness information, contributing factors, and corrective actions. The multi-step workflow guides reporters through systematic documentation while ensuring compliance with OSHA recordkeeping requirements. Suitable for injuries, accidents, property damage, and near-miss events.
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export function incidentReportForm(form: FormTs) {
// Workplace Incident Report Form
// Demonstrates: Pages (multi-page), Datepicker, Timepicker, Dropdown, RadioButton, CheckboxList, Textarea, Slider
// Focus: Structured incident documentation with investigation workflow
// ============================================
// HEADER
// ============================================
form.addRow(row => {
row.addTextPanel('header', {
label: 'Workplace Incident Report',
computedValue: () => 'Document all workplace incidents promptly and accurately. This information is essential for investigation and prevention.',
customStyles: {
backgroundColor: '#b91c1c',
color: 'white',
padding: '24px',
borderRadius: '12px',
textAlign: 'center'
}
});
});
// ============================================
// MULTI-PAGE WIZARD
// ============================================
const pages = form.addPages('incidentPages', {
heightMode: 'current-page'
});
// ============================================
// PAGE 1: Incident Details
// ============================================
const page1 = pages.addPage('details');
const detailsSection = page1.addSubform('detailsSection', {
title: 'Step 1: Incident Details'
});
detailsSection.addRow(row => {
row.addDropdown('incidentType', {
label: 'Type of Incident',
options: [
{ id: 'injury', name: 'Injury / Illness' },
{ id: 'near-miss', name: 'Near Miss (No Injury)' },
{ id: 'property', name: 'Property Damage' },
{ id: 'environmental', name: 'Environmental Release' },
{ id: 'security', name: 'Security Incident' },
{ id: 'vehicle', name: 'Vehicle Accident' },
{ id: 'other', name: 'Other' }
],
placeholder: 'Select incident type',
isRequired: true
});
});
detailsSection.addRow(row => {
row.addDatepicker('incidentDate', {
label: 'Date of Incident',
isRequired: true,
maxDate: () => new Date().toISOString()
}, '1fr');
row.addTimepicker('incidentTime', {
label: 'Time of Incident',
isRequired: true
}, '1fr');
});
detailsSection.addRow(row => {
row.addTextbox('location', {
label: 'Exact Location',
placeholder: 'Building, floor, room, or specific area',
isRequired: true
});
});
detailsSection.addRow(row => {
row.addDropdown('severity', {
label: 'Initial Severity Assessment',
options: [
{ id: 'minor', name: 'Minor - First aid only' },
{ id: 'moderate', name: 'Moderate - Medical treatment required' },
{ id: 'serious', name: 'Serious - Lost time or hospitalization' },
{ id: 'critical', name: 'Critical - Life threatening' },
{ id: 'fatality', name: 'Fatality' },
{ id: 'near-miss', name: 'Near Miss - No injury/damage' }
],
placeholder: 'Select severity',
isRequired: true
});
});
detailsSection.addRow(row => {
row.addTextPanel('severityWarning', {
computedValue: () => {
const severity = detailsSection.dropdown('severity')?.value();
if (severity === 'serious' || severity === 'critical' || severity === 'fatality') {
return '⚠️ CRITICAL: Immediately notify your supervisor, safety manager, and HR. Preserve the scene for investigation.';
}
return '';
},
customStyles: () => ({
backgroundColor: '#fee2e2',
color: '#991b1b',
padding: '12px',
borderRadius: '6px',
fontWeight: 'bold',
textAlign: 'center'
}),
isVisible: () => {
const severity = detailsSection.dropdown('severity')?.value();
return severity === 'serious' || severity === 'critical' || severity === 'fatality';
}
});
});
// Navigation buttons for page 1
const nav1 = page1.addSubform('nav1', { sticky: 'bottom' });
nav1.addRow(row => {
row.addButton('nextBtn1', {
label: 'Continue to Description →',
onClick: () => pages.goToPage('description'),
isDisabled: () => !detailsSection.dropdown('incidentType')?.value()
});
});
// ============================================
// PAGE 2: Description
// ============================================
const page2 = pages.addPage('description');
const descSection = page2.addSubform('descSection', {
title: 'Step 2: What Happened?'
});
descSection.addRow(row => {
row.addTextarea('description', {
label: 'Describe what happened',
placeholder: 'Provide a clear, factual account of the incident. Include what the person was doing, what equipment was involved, and the sequence of events leading to the incident...',
rows: 6,
autoExpand: true,
isRequired: true
});
});
descSection.addRow(row => {
row.addTextarea('immediateActions', {
label: 'Immediate actions taken',
placeholder: 'What was done immediately after the incident? First aid, evacuation, area secured, equipment shut down, etc.',
rows: 3,
autoExpand: true
});
});
// Injury details (conditional)
const injurySection = page2.addSubform('injurySection', {
title: 'Injury Details',
isVisible: () => detailsSection.dropdown('incidentType')?.value() === 'injury',
customStyles: { backgroundColor: '#fef2f2', padding: '16px', borderRadius: '8px' }
});
injurySection.addRow(row => {
row.addCheckboxList('injuryType', {
label: 'Type of Injury (select all that apply)',
options: [
{ id: 'cut', name: 'Cut / Laceration' },
{ id: 'bruise', name: 'Bruise / Contusion' },
{ id: 'sprain', name: 'Sprain / Strain' },
{ id: 'fracture', name: 'Fracture / Break' },
{ id: 'burn', name: 'Burn' },
{ id: 'eye', name: 'Eye Injury' },
{ id: 'respiratory', name: 'Respiratory' },
{ id: 'amputation', name: 'Amputation' },
{ id: 'other', name: 'Other' }
],
orientation: 'vertical'
});
});
injurySection.addRow(row => {
row.addCheckboxList('bodyPart', {
label: 'Body Part Affected',
options: [
{ id: 'head', name: 'Head / Face' },
{ id: 'neck', name: 'Neck' },
{ id: 'shoulder', name: 'Shoulder' },
{ id: 'arm', name: 'Arm / Elbow' },
{ id: 'hand', name: 'Hand / Wrist' },
{ id: 'fingers', name: 'Fingers' },
{ id: 'back', name: 'Back' },
{ id: 'chest', name: 'Chest / Torso' },
{ id: 'leg', name: 'Leg / Knee' },
{ id: 'foot', name: 'Foot / Ankle' },
{ id: 'toes', name: 'Toes' }
],
orientation: 'vertical'
});
});
injurySection.addRow(row => {
row.addRadioButton('medicalTreatment', {
label: 'Medical treatment received',
options: [
{ id: 'none', name: 'No treatment needed' },
{ id: 'first-aid', name: 'First aid on site' },
{ id: 'clinic', name: 'Clinic / Urgent care visit' },
{ id: 'er', name: 'Emergency room' },
{ id: 'hospital', name: 'Hospital admission' }
],
orientation: 'vertical'
});
});
// Navigation for page 2
const nav2 = page2.addSubform('nav2', { sticky: 'bottom' });
nav2.addRow(row => {
row.addButton('backBtn2', {
label: '← Back',
onClick: () => pages.goToPage('details')
}, '1fr');
row.addButton('nextBtn2', {
label: 'Continue to People Involved →',
onClick: () => pages.goToPage('people'),
isDisabled: () => !descSection.textarea('description')?.value()
}, '1fr');
});
// ============================================
// PAGE 3: People Involved
// ============================================
const page3 = pages.addPage('people');
const injuredSection = page3.addSubform('injuredSection', {
title: 'Step 3: Injured/Affected Person',
isVisible: () => detailsSection.dropdown('incidentType')?.value() === 'injury'
});
injuredSection.addRow(row => {
row.addTextbox('injuredName', {
label: 'Injured Person\'s Name',
placeholder: 'Full name',
isRequired: () => detailsSection.dropdown('incidentType')?.value() === 'injury'
}, '1fr');
row.addTextbox('injuredTitle', {
label: 'Job Title / Department',
placeholder: 'Position'
}, '1fr');
});
injuredSection.addRow(row => {
row.addDropdown('employeeType', {
label: 'Employment Status',
options: [
{ id: 'employee', name: 'Employee' },
{ id: 'contractor', name: 'Contractor' },
{ id: 'visitor', name: 'Visitor' },
{ id: 'vendor', name: 'Vendor' },
{ id: 'public', name: 'Member of Public' }
],
placeholder: 'Select status'
}, '1fr');
row.addTextbox('supervisor', {
label: 'Supervisor Name',
placeholder: 'Direct supervisor'
}, '1fr');
});
// Reporter Info
const reporterSection = page3.addSubform('reporterSection', {
title: 'Report Filed By'
});
reporterSection.addRow(row => {
row.addTextbox('reporterName', {
label: 'Your Name',
placeholder: 'Person filing this report',
isRequired: true
}, '1fr');
row.addTextbox('reporterTitle', {
label: 'Your Title / Department',
placeholder: 'Position'
}, '1fr');
});
reporterSection.addRow(row => {
row.addTextbox('reporterPhone', {
label: 'Phone Number',
placeholder: 'For follow-up questions'
}, '1fr');
row.addEmail('reporterEmail', {
label: 'Email',
placeholder: 'your@email.com'
}, '1fr');
});
// Witnesses
const witnessSection = page3.addSubform('witnessSection', {
title: 'Witnesses'
});
witnessSection.addRow(row => {
row.addRadioButton('hasWitnesses', {
label: 'Were there any witnesses?',
options: [
{ id: 'yes', name: 'Yes' },
{ id: 'no', name: 'No' },
{ id: 'unknown', name: 'Unknown' }
],
orientation: 'horizontal'
});
});
witnessSection.addRow(row => {
row.addTextarea('witnessInfo', {
label: 'Witness names and contact information',
placeholder: 'List all witnesses with their names and how to contact them...',
rows: 2,
autoExpand: true,
isVisible: () => witnessSection.radioButton('hasWitnesses')?.value() === 'yes'
});
});
// Navigation for page 3
const nav3 = page3.addSubform('nav3', { sticky: 'bottom' });
nav3.addRow(row => {
row.addButton('backBtn3', {
label: '← Back',
onClick: () => pages.goToPage('description')
}, '1fr');
row.addButton('nextBtn3', {
label: 'Continue to Contributing Factors →',
onClick: () => pages.goToPage('factors')
}, '1fr');
});
// ============================================
// PAGE 4: Contributing Factors
// ============================================
const page4 = pages.addPage('factors');
const factorsSection = page4.addSubform('factorsSection', {
title: 'Step 4: Contributing Factors'
});
factorsSection.addRow(row => {
row.addMatrixQuestion('contributingFactors', {
label: 'Identify factors that may have contributed to this incident:',
rows: [
{ id: 'training', label: 'Lack of training / knowledge' },
{ id: 'procedure', label: 'Procedure not followed' },
{ id: 'equipment', label: 'Equipment failure / defect' },
{ id: 'ppe', label: 'PPE not used / inadequate' },
{ id: 'housekeeping', label: 'Poor housekeeping' },
{ id: 'supervision', label: 'Inadequate supervision' },
{ id: 'fatigue', label: 'Fatigue / stress' },
{ id: 'rushing', label: 'Rushing / time pressure' },
{ id: 'distraction', label: 'Distraction' },
{ id: 'environment', label: 'Environmental conditions' }
],
columns: [
{ id: 'yes', label: 'Contributing' },
{ id: 'possible', label: 'Possible' },
{ id: 'no', label: 'Not a Factor' },
{ id: 'unknown', label: 'Unknown' }
],
striped: true,
fullWidth: true
});
});
factorsSection.addSpacer();
factorsSection.addRow(row => {
row.addSlider('recurrenceRisk', {
label: 'How likely is this type of incident to happen again?',
min: 1,
max: 10,
step: 1,
defaultValue: 5,
showValue: true,
unit: '/10'
});
});
factorsSection.addRow(row => {
row.addTextPanel('riskWarning', {
computedValue: () => {
const risk = factorsSection.slider('recurrenceRisk')?.value();
if (!risk) return '';
if (risk <= 3) return 'Low recurrence risk - Document and monitor.';
if (risk <= 5) return 'Moderate risk - Corrective actions recommended.';
if (risk <= 7) return 'Elevated risk - Priority corrective actions needed.';
return 'High risk - Immediate action required to prevent recurrence!';
},
customStyles: () => {
const risk = factorsSection.slider('recurrenceRisk')?.value();
let bg = '#dcfce7';
if (risk && risk > 3) bg = '#fef3c7';
if (risk && risk > 5) bg = '#ffedd5';
if (risk && risk > 7) bg = '#fee2e2';
return {
backgroundColor: bg,
padding: '10px',
borderRadius: '6px',
textAlign: 'center'
};
},
isVisible: () => !!factorsSection.slider('recurrenceRisk')?.value()
});
});
factorsSection.addSpacer();
factorsSection.addRow(row => {
row.addTextarea('rootCause', {
label: 'Preliminary Root Cause Analysis',
placeholder: 'What was the underlying cause of this incident? Consider the 5 Whys technique...',
rows: 3,
autoExpand: true
});
});
// Navigation for page 4
const nav4 = page4.addSubform('nav4', { sticky: 'bottom' });
nav4.addRow(row => {
row.addButton('backBtn4', {
label: '← Back',
onClick: () => pages.goToPage('people')
}, '1fr');
row.addButton('nextBtn4', {
label: 'Continue to Review →',
onClick: () => pages.goToPage('review')
}, '1fr');
});
// ============================================
// PAGE 5: Review & Submit
// ============================================
const page5 = pages.addPage('review');
const reviewSection = page5.addSubform('reviewSection', {
title: 'Step 5: Review & Submit'
});
reviewSection.addRow(row => {
row.addTextPanel('summaryContent', {
computedValue: () => {
const type = detailsSection.dropdown('incidentType')?.value();
const date = detailsSection.datepicker('incidentDate')?.value();
const severity = detailsSection.dropdown('severity')?.value();
const location = detailsSection.textbox('location')?.value();
const reporter = reporterSection.textbox('reporterName')?.value();
const risk = factorsSection.slider('recurrenceRisk')?.value();
const typeLabels: Record<string, string> = {
'injury': 'Injury/Illness', 'near-miss': 'Near Miss', 'property': 'Property Damage',
'environmental': 'Environmental', 'security': 'Security', 'vehicle': 'Vehicle Accident', 'other': 'Other'
};
const severityLabels: Record<string, string> = {
'minor': 'Minor', 'moderate': 'Moderate', 'serious': 'Serious',
'critical': 'Critical', 'fatality': 'Fatality', 'near-miss': 'Near Miss'
};
let summary = '📋 INCIDENT REPORT SUMMARY\n';
summary += '━'.repeat(32) + '\n\n';
if (type) summary += `Type: ${typeLabels[type] || type}\n`;
if (date) summary += `Date: ${new Date(date).toLocaleDateString()}\n`;
if (location) summary += `Location: ${location}\n`;
if (severity) summary += `Severity: ${severityLabels[severity] || severity}\n`;
if (risk) summary += `Recurrence Risk: ${risk}/10\n`;
summary += '\n';
if (reporter) summary += `Reported by: ${reporter}\n`;
return summary;
},
customStyles: () => {
const severity = detailsSection.dropdown('severity')?.value();
let bg = '#f3f4f6';
let border = '#6b7280';
if (severity === 'minor' || severity === 'near-miss') { bg = '#dcfce7'; border = '#22c55e'; }
if (severity === 'moderate') { bg = '#fef3c7'; border = '#f59e0b'; }
if (severity === 'serious' || severity === 'critical' || severity === 'fatality') { bg = '#fee2e2'; border = '#ef4444'; }
return {
backgroundColor: bg,
borderLeft: `4px solid ${border}`,
padding: '16px',
borderRadius: '8px',
whiteSpace: 'pre-wrap',
fontFamily: 'monospace',
fontSize: '14px'
};
}
});
});
reviewSection.addRow(row => {
row.addTextarea('correctiveActions', {
label: 'Recommended Corrective Actions',
placeholder: 'What actions should be taken to prevent this from happening again?',
rows: 3,
autoExpand: true
});
});
reviewSection.addRow(row => {
row.addCheckbox('confirmAccuracy', {
label: 'I confirm that all information provided in this report is accurate and complete to the best of my knowledge.',
isRequired: true
});
});
// Navigation for page 5
const nav5 = page5.addSubform('nav5', { sticky: 'bottom' });
nav5.addRow(row => {
row.addButton('backBtn5', {
label: '← Back to Edit',
onClick: () => pages.goToPage('factors')
});
});
// ============================================
// FORM CONFIGURATION
// ============================================
form.configureSubmitButton({
label: 'Submit Incident Report',
isVisible: () => reviewSection.checkbox('confirmAccuracy')?.value() === true
});
form.configureCompletionScreen({
type: 'text',
title: 'Incident Report Submitted',
message: 'Your incident report has been filed. A copy has been sent to the safety department and relevant supervisors. You may be contacted for additional information during the investigation. Thank you for reporting this incident promptly.'
});
}
Frequently Asked Questions
When should I file an incident report?
File a report immediately for any workplace injury, accident, property damage, or near-miss. Even minor incidents should be documented - they often reveal hazards that could cause serious injuries. Most organizations require reporting within 24 hours.
What incidents are OSHA recordable?
OSHA requires recording work-related injuries/illnesses resulting in death, days away from work, restricted work, medical treatment beyond first aid, loss of consciousness, or significant injury/illness diagnosed by a physician. Near-misses don't require OSHA recording but should be documented internally.
Who should complete the incident report?
The injured employee or the person who witnessed/discovered the incident should initiate the report. Supervisors then review, add investigation findings, and ensure corrective actions are assigned. Safety managers may conduct additional investigation.
What if I don't know all the details?
Fill in what you know factually and indicate where information is unknown or estimated. Follow up with witnesses and involved parties to complete missing details. Accuracy is more important than completeness - update the report as you learn more.
How long should we retain incident reports?
OSHA requires keeping injury/illness records for 5 years. Best practice is to retain all incident documentation permanently for liability protection, trend analysis, and demonstrating safety program effectiveness. Store securely with limited access.