Sample Slip and Fall Incident Report Form

Make sure there’s a written report for slip and falls away from home. Use this form if the property manager didn’t make an incident report.

If you suffer a slip and fall injury on someone else’s property, you have the right to seek compensation. Usually, that means filing a claim with the property owner’s liability insurance carrier. However, you won’t get far with an injury claim unless you can establish when and where you got hurt.

Never leave the scene of a slip and fall without reporting the incident. Most stores and other businesses will have an incident report form to be filled out by you or the store management. You can ask for a copy of the completed form, but most businesses won’t give you a copy just by asking. It’s enough to know that a written report of your fall is on record.

If the property owner or manager says they don’t fill out an incident report form for accidents like yours, get the name of the employee you notified, then use this free resource to create your own written incident report.

Click on the image below to download the PDF report form:

Documenting Your Slip and Fall Is Vital

What happens after a slip and fall accident can make or break your claim. The worst thing you can do after a slip and fall is to pick yourself up and leave in embarrassment. You may have sustained significant injuries that won’t be apparent for several hours. After the shock and adrenaline from a violent fall wears off, your pain and other symptoms will show.

You must connect your slip and fall injuries to the date, time, and location of the accident.

After a fall, ask an employee or a bystander to get the manager. Tell the manager you want an incident report made of your fall. Give them your name and contact information. If they say they don’t use an incident report form, get the name of the employees or manager you spoke to at the scene.

If your injuries are immediately obvious, your first priority is to get emergency medical attention. Never refuse medical attention at the scene. If an ambulance has been called, let the paramedics look you over. Cooperate if they want to take you to the hospital. The ambulance report will document the place and date of your injuries.

Waiting to report your injury can seriously undermine your chances of getting fair compensation, as will a delay in medical treatment. Any insurance company will use a delay as an excuse to deny your injury claim. The adjuster will argue that your injuries did not happen on their insured’s property.

How to Use This Slip and Fall Incident Report Form

If you aren’t sure that the property owner filed an incident report after your slip and fall accident, fill out this handy incident report form as soon as possible after the accident.

The top of the report form is for the date and time of your slip and fall, the business name and address, where you fell (like a parking lot, produce section, etc.), and the names of the store employees you talked to. You’ll also fill in your contact information and the date you are preparing the incident report.

Provide as much information as you can in the sections provided. Be factual. Don’t offer opinions or criticism.

Describe the incident in detail, including where you were on the property and how you fell. Be specific if there was a wet floor, debris in the walkway, ice or snow, or any other hazardous condition that led to your fall.

Be sure to point out that there were no wet floor signs or other warnings of the danger, and there was nothing you could have done to prevent your fall.

You won’t know the extent of your injuries, but you can describe the pain you experienced, any numbness, swelling, or bruising that’s immediately apparent. Also describe if you were unable to move a body part, or unable to walk properly, or unable to stand without help.

The incident report should include any treatments you got at the scene (including first aid from an employee) or immediately afterward.

Include the name and contact information for any witnesses to your slip and fall, even if the witness was a friend or family member.

Sign and date your incident report form. Make a copy of the first page to mail to the property owner. Keep the original to put in your injury claim file.

Helpful Tips After a Slip and Fall

Never make excuses or apologize for a slip and fall. You may be embarrassed, but this is not the time to make jokes about being clumsy or say, “Only my pride was injured.”

If you aren’t taken directly to the hospital after a slip and fall, you must seek medical attention as soon as possible, preferably the same day. You can see your primary health care provider, visit an urgent care center, or go to the hospital emergency room.

Be sure to tell every medical provider exactly when, where, and how you were injured.

Write down everything you can remember while the circumstances surrounding the slip and fall are fresh in your mind. No detail is too small for your injury diary. For example, if someone who works where you fell apologized or made excuses for the hazard that caused your fall, that information can help your injury claim.

Whether you decide to handle your own slip and fall claim or hire a personal injury attorney,  an incident report and timely medical attention can help you get the injury compensation you deserve.