Farm Incident and Accident Report
Report all incidents promptly regardless of severity. Accurate incident documentation is required by law and essential for preventing future occurrences.
- Industry: Agriculture
- Frequency: As Needed
- Estimated Time: 20-30 minutes
- Role: Supervisor / Safety Officer
- Total Items: 32
- Compliance: USDA Record Requirements, OSHA Recordkeeping (29 CFR 1904), Workers Compensation Requirements, Agricultural Best Practices
Incident Classification
Classify the type of incident.
- Incident Type
- Severity Level
- OSHA Recordable Incident?
- Workers Comp Claim Filed?
Person(s) Involved
Document individuals involved.
- Injured/Involved Person Name
- Employee ID
- Job Title
- Years in Position
- Supervisor Name
- Witnesses
Incident Details
Describe what happened.
- Specific Location
- Activity at Time of Incident
- Equipment/Machinery Involved
- Detailed Description of Incident
- Body Part Affected (if injury)
- Nature of Injury/Illness
Immediate Response
Document actions taken.
- First Aid Administered?
- First Aid Description
- Professional Medical Treatment Sought?
- Hospital/Clinic Name (if applicable)
- Emergency Services Called?
- Time Lost from Work
Root Cause Analysis
Investigate contributing factors.
- Unsafe Act Involved?
- Unsafe Act Description
- Unsafe Condition Involved?
- Unsafe Condition Description
- Contributing Factors
- Was This Incident Preventable?
Initial Safety Assessment
Preliminary safety and compliance verification
- Work area safe and hazard-free?
- Required PPE available and in good condition?
- Emergency exits clear and marked?
- First aid supplies accessible?
Related Agriculture Checklists
- Daily Farm Operations Log
- Pesticide and Chemical Application Record
- Agricultural Employee Time and Attendance Record
- Farm Inventory and Supplies Log
- Tractor Pre-Operation Check
- Grain Storage Inspection
- Tractor Pre-Operation Checklist
- Grain Bin Safety Checklist
Related Recordkeeping Checklists
- Daily Farm Operations Log - FREE Download
- Pesticide and Chemical Application Record - FREE Download
- Agricultural Employee Time and Attendance Record - FREE Download
- Farm Inventory and Supplies Log - FREE Download
- Farm Equipment Maintenance Log - FREE Download
- Agricultural Sales and Transaction Record - FREE Download
- Daily Weather Observation Log - FREE Download
- Agricultural Compliance Documentation Checklist - FREE Download
- Farm Financial Transaction and Expense Log - FREE Download
Why Use This Farm Incident and Accident Report?
This farm incident and accident report helps agriculture teams maintain compliance and operational excellence. Designed for supervisor / safety officer professionals, this checklist covers 32 critical inspection points across 6 sections. Recommended frequency: as needed.
Ensures compliance with USDA Record Requirements, OSHA Recordkeeping (29 CFR 1904), Workers Compensation Requirements, Agricultural Best Practices. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Farm Incident and Accident Report cover?
This checklist covers 32 inspection items across 6 sections: Incident Classification, Person(s) Involved, Incident Details, Immediate Response, Root Cause Analysis, Initial Safety Assessment. It is designed for agriculture operations and compliance.
How often should this checklist be completed?
This checklist should be completed as needed. Each completion takes approximately 20-30 minutes.
Who should use this Farm Incident and Accident Report?
This checklist is designed for Supervisor / Safety Officer professionals in the agriculture industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.