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incident report form

Have your own record when the account is questioned.

Incident report form — Have your own record when the account is questioned. Keep notes, photos and messages somewhere the employer cannot access. No legal advice is provided.

Your photos and files stay on your device, so keep them.

Your free incident record worksheet.

A worksheet, not an official form; use your regulator's / carrier's / insurer's own form where one is required.

  • Notes reference
  • Photo references
  • Message references

Check your regulator's own form. The printable version lists the source behind every field. CSV versions have an instruction row above the headings.

Then date your filled-in copy.

Keep the completed copy and its source records. A time receipt dates those exact bytes; it does not establish that an entry is true or accepted. Save a new copy when the record changes.

Your record, one step at a time.

Your photos and files stay on your device, so keep them.

Local preview: files are fingerprinted here. Notes and progress stay in this browser. Keep downloaded copies; browser storage is not a backup.

Use a personal device and account the employer cannot access. This preview stores notes in this browser. No legal advice.

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How?

A worksheet, not an official form; use your regulator's / carrier's / insurer's own form where one is required.

Fill in

By making a receipt you agree to the Terms and Privacy Policy. The Bitcoin record is permanent.

Printable version

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    How?

    Write what you remember in your own words. The saved time uses your device’s clock.

    How to keep notes that hold up
    Write it down

    By making a receipt you agree to the Terms and Privacy Policy. The Bitcoin record is permanent.

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      How?

      Add the exact original files for this part of the record. Keep them unchanged; a different export or edit has a different fingerprint.

      Add link and screenshots

      The link is recorded, not fetched or verified.

        0 items
        How?

        Add the exact original files for this part of the record. Keep them unchanged; a different export or edit has a different fingerprint.

        Add link and screenshots

        The link is recorded, not fetched or verified.

          By making a receipt you agree to the Terms and Privacy Policy. The Bitcoin record is permanent.

          How to keep notes that hold up

          Write notes as soon as you can. Keep the original account rather than replacing it later; the venue decides what weight it gets.

          1. Write it down straight away, on paper or in the box on a step.
          2. Put the date, time and place at the top, and who you spoke to.
          3. Use their words where you can; separate what you saw from what you were told.
          4. Sign or initial a paper note, photograph it and add the photo.
          5. Never edit an old note. Add a new dated entry when something changes. A device save time is not independent time evidence or proof of event order.
          Workplace incident record

          01 · Keep the exact files

          Keep notes, photos and messages somewhere the employer cannot access. No legal advice is provided.

          Records to keep: Notes · Photos · Messages

          Workplace incident record

          02 · Date the file’s code

          Your device fingerprints the selected file or manifest. Dated follows an independent timestamp; Permanent follows Bitcoin anchoring.

          An independent time, tied to the exact bytes.

          Workplace incident record

          03 · Keep the evidence

          Retain originals and the actual report or acknowledgment. The worksheet does not submit a report or start a legal process.

          Keep the originals too. A changed or compressed copy has a different fingerprint.

          Try a file. It stays here.

          Make a test receipt on this device.

          By making a receipt you agree to the Terms and Privacy Policy. The Bitcoin record is permanent.

          or drop a file here

          Real cases: why the saved copy matters.

          Real cases where dated records mattered. We don’t claim a time receipt would have changed the result.

          US federal · 2011

          Emails can answer claims of late-made statements

          A worker said witness statements were made up after the case began because they were missing from a tracking system. Emails written at the time undermined that claim. The court ruled for the employer and union before trial.

          Summarized on Oct 29, 2026

          Read the decision ›
          US federal · 2018

          A journal can conflict with a later account

          A worker said managers still asked him to shave after he told human resources about a skin condition. His journal lacked those later events, and his earlier account also clashed with them. The court did not rely on his later claim.

          Summarized on Oct 29, 2026

          Read the decision ›
          Texas · 2023

          Records made at the time can support firing

          A worker said the firm's reasons for firing them hid bias or payback for complaints. Records made at the time backed the firm's account of behavior and complaints. The appeal court kept the firm's win.

          Summarized on Oct 29, 2026

          Read the decision ›

          What courts, schemes and regulators say.

          Positions below refer to the cited rule or record type, not endorsement of Timevolt. This service is not represented as an eIDAS qualified timestamp provider. A non-qualified timestamp does not receive the qualified timestamp presumption.

          Accepts · US federal courts

          Federal Rules of Evidence 902(14)

          Data copied from an electronic device, storage medium or file can be authenticated by a process of digital identification, certified by a qualified person. The 2017 committee note says a hash value is the usual means.

          This is about authenticating that a copy matches the original (hash). It does not make the content true or settle who created it. It needs a certification, and the judge decides admissibility and weight.

          Source summary as of 2026-10-28. Check the current source and applicable local rules.

          Read the source
          Silent · US (EEOC)

          EEOC charge filing

          The standard deadline to file a charge is 180 calendar days, extended to 300 where a state or local agency enforces a law against the same discrimination.

          The page says nothing about how to keep records or about dated or digital records. It is useful for the deadline FAQ only.

          Source summary as of 2026-10-28. Check the current source and applicable local rules.

          Read the source

          Other ways to do this

          Prices change. Check each provider’s site for current prices and service details.

          • Traily

            Provides employee incident diary with locked timestamped entries, file attachments and PDF export.

            Visit site
          • Smartsheet free incident forms

            Provides downloadable incident, witness and near-miss forms.

            Visit site
          • Workmetrics Incident Report

            Provides mobile capture of incidents, hazards and near misses with submission to a chosen contact.

            Visit site
          • SafeWork NSW templates

            Provides hazard and incident forms in PDF and Word, plus an injury register.

            Visit site

          Proves / Doesn’t prove

          Proves

          A completed time receipt shows that the exact selected file existed by the independently witnessed time. You can check whether a later copy has the same bytes. It does not establish creation time, authorship, identity, event order, location or the truth of the contents.

          Doesn’t prove

          It does not prove who wrote or took them, where, that what they show is true, that the incident happened as described, or how any employer, agency or court will weigh them.

          This cannot establish who wrote a record, true events, identity or a legal outcome.

          These are the bounds of a completed proof. The local tester does not establish any time. The chosen court, scheme or regulator decides what to accept.

          Questions, answered plainly.

          Your file stays on your device. During normal receipt creation, your device sends a randomized code made from its fingerprint, plus encrypted recovery data. It doesn't send the plain fingerprint or the random value that opens the code. Keep the original file and the complete receipt for checking. Privacy Policy.

          What should a workplace incident report include?

          Date and time, place, what happened in plain facts, who was there (by role or name), what you did and who you told, and any photos or messages. Write it as soon as you can.

          Source summary as of October 30, 2026. Check the current source and its scope.

          Context for this answer
          How long do I have to file a discrimination charge?

          With the US EEOC the standard deadline is 180 calendar days, or 300 where a state or local agency also enforces a law against the same discrimination. Other issues and countries have different limits.

          Source summary as of October 30, 2026. Check the current source and its scope.

          Context for this answer
          Does a time receipt prove my report is true?

          A completed time receipt shows that the exact selected file existed by the independently witnessed time. You can check whether a later copy has the same bytes. It does not establish creation time, authorship, identity, event order, location or the truth of the contents.

          Do my notes and photos get uploaded?

          Your file stays on your device. During normal receipt creation, your device sends a randomized code made from its fingerprint, plus encrypted recovery data. It doesn't send the plain fingerprint or the random value that opens the code. Keep the original file and the complete receipt for checking.

          Why does the date on my notes matter?

          In disputes, courts look at whether records were made at the time. One employee's claim that statements were written later failed for lack of evidence, and another's own journal contradicted what he later swore.

          Source summary as of October 30, 2026. Check the current source and its scope.

          Context for this answer
          Will a court accept a hash of my file?

          US federal rules let a hash be used to authenticate a copy of electronic data with a proper certification. Whether it is admitted and how much weight it gets is up to the court or agency.

          Source summary as of October 30, 2026. Check the current source and its scope.

          Context for this answer
          Is emailing the notes to myself enough?

          It helps a little but the timestamp comes from your mail provider and the account holder controls it. An independent timestamp authority is a stronger dated record.

          The file tester runs on your device. It does not issue a timestamp or take a payment.

          Keep the records you already have.

          Keep your original files and any existing official records while the receipt service is being prepared.