Incident Report
1. Reporter
- Your name and role
- Phone and email
- Date and time of this report
2. The incident
- Date and time of the incident
- Or when it is alleged to have happened
- Location
- Date and time key personnel became aware
- Reportable incident deadlines run from this point
- Support being delivered at the time
3. People involved
- Participant(s) involved
- Workers involved
- Other people involved
- Witnesses and contact details
4. What happened
Facts in the order they happened. What you saw and heard — not opinions or guesses.
- Before the incident
- During the incident
- After the incident
5. Injuries and treatment
- Injuries to anyone involved
- First aid or medical treatment given, by whom
6. Immediate actions
- What was done to make everyone safe
- Emergency services or police called?
- No / Yes — time and event number
- Evidence preserved (if a crime may have occurred)
7. Notifications
- Key personnel / supervisor told — name, date, time
- Participant's family, guardian or nominee told — with consent
- Name, date, time
- Others told
- e.g. plan manager, support coordinator, behaviour support practitioner
8. Reportable incident assessment
Tick any that apply, or are alleged. If any is ticked, notify the NDIS Commission through the Commission portal within the deadline.
9. Commission notification (if reportable)
- Immediate Notification lodged — date, time, reference number
- 5 Day Form lodged — date, reference number
- Final report requested?
- No / Yes — due date
10. Follow-up
- Investigation or review — who, and outcome
- Support for the participant and workers affected
- Changes to prevent it happening again
- Support plan, risk assessment, training, policy
- Participant told how the incident was managed — date
- Closed by — name, signature, date
Free template from Suppora · suppora.com.au/templates/ndis-incident-report-template

