Internal accident report

Records what happened in a workplace accident or near miss, who was involved and what follows – for internal follow-up.

For: Businesses, workshops, sites

Template language

Fill in: by hand, typed, spoken or from your documents – the AI proposes, you review.

The fields for Supervisor are ready. Get it signed: soon with Signovoza.

Every copy starts empty. The template is created in your browser; we store none of your entries.

Fields · Who fills in what

Details

Name of the person involved (required)You, before sending
DepartmentYou, before sending
Date (required)You, before sending
TimeYou, before sending
Place (required)You, before sending
Type of event (required)You, before sending
WitnessesYou, before sending

What happened

Description of events (required)You, before sending
Injury / damageYou, before sending

First aid

First aid given byYou, before sending
Further treatmentYou, before sending
Work stoppedYou, before sending
Resumed onYou, before sending
Expected to be unfit for work over 3 daysYou, before sending
Entered in the first-aid bookYou, before sending

Actions

Actions to prevent a repeatfilled in by Supervisor
Carried out byfilled in by Supervisor
Due byfilled in by Supervisor
Safety officer informedfilled in by Supervisor
Works council informedfilled in by Supervisor

Signatures

Place, date – Signature reporterYou, before sending
Signature reporter (required)You, before sending
Place, date – Signature supervisorfilled in by Supervisor
Signature supervisor (required)filled in by Supervisor

Does the other side need to sign? Soon with Signovoza.

Internal accident reportThis sheet is for internal records. Reports to outside bodies go through their own forms.Contains health data: pass it on only to the people who need it for their job.Name of the person involved *DepartmentDate *DD/MM/YYYYTimeHH:MMPlace *Type of event *Accident with injuryNear missProperty damageWitnessesWhat happenedDescription of events *Injury / damageFirst aidFirst aid given byFurther treatmentnonedoctorhospitalWork stoppedyesnoResumed onDD/MM/YYYYExpected to be unfit for work over 3 daysyesnounknownEntered in the first-aid bookyesnoExpected absence from work: report the accident to the competent insurer within the legaldeadline (in Germany, over 3 days: Berufsgenossenschaft, § 193 SGB VII).ActionsActions to prevent a repeat (Supervisor)Page 1 of 2

2 pages

Frequently asked questions

Is the “Internal accident report” template free?

Yes. Filling in, downloading and adapting run in your browser and cost nothing, even without an account. Without an account the PDF carries “Created with Docuvoza” at the bottom.

Is what I enter stored?

No. Every copy starts empty and is filled in in your browser; the template keeps no answers. The working copy stays in this browser for up to 7 days, or until you choose Start over. Account storage, share links and fill requests are unavailable at launch. Files for server tools are deleted after 60 minutes.

Can the other side sign?

The fields for Supervisor are ready. Signature requests through Signovoza are not yet available at launch; download the form and pass it on yourself.

Can I adapt the template?

Yes. “Adapt in the form editor” opens it with all fields and roles; you download the result as a PDF. Your own templates come with accounts.

Has the template been legally reviewed?

No. The templates are operational structures for day-to-day work – not legal advice and not reviewed contract wording. Adapt them to your situation where needed.

These templates are operational structures for day-to-day work – not legal advice and not reviewed contract wording. Adapt them to your situation where needed.