survey examples Business & Marketing

Incident Report

  • Incident Report Form

    Have you or someone else been involved in an incident which resulted in an injury?
  • 1. What is your full name?

  • 2. What is your email? *

    Please, enter e-mail address in a form e.g.:
  • 3. What is the full name of the person injured? *

  • 4. Where were they injured? *

    You can select several answers.
  • 5. How badly does this injury affect them?

    You can give only one answer.
  • 6. How many people witnessed the incident?

    You can give only one answer.
  • 7. What was the nature of the incident?

    Provide as much detail as you can. Include the time and location of the incident.
  • 8. Have steps been taken to reduce the chances of this happening again? *

    You can give only one answer.


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