Free template
Free NDIS incident report form template
Written by James, creator of BluetailPublished 25 September 2026
A ready-to-use Incident Report Form for small NDIS providers and sole traders. It walks a worker through making everyone safe, recording what happened, and passing it on - then walks management through deciding whether the incident must be reported to the NDIS Quality and Safeguards Commission, assessing it, and closing it out. Pre-fill your business details, download the Word file or copy the text. Free, with no sign-up.
Who it’s for
Sole traders and small NDIS providers - support workers, community access, personal care, domestic assistance and similar supports. Registered providers must have an incident management system that meets the Incident Rules, and a report form is where it is put into practice. Unregistered providers are still bound by the NDIS Code of Conduct, and recording incidents properly protects participants and your business either way.
How to use it
- Pre-fill your details below and they drop into the [highlighted] prompts automatically.
- Complete the two Fill in notes - your after-hours contact, and who makes Commission notifications.
- Show every worker where the form is and when to use it.
- Practise with one imagined incident before you ever need it for real.
What’s in the form, and why each part is there
The NDIS (Incident Management and Reportable Incidents) Rules 2018 set out what an incident record must contain and how every incident must be assessed. The form is built around those requirements, in the order things actually happen:
01Incident details
Date, time and place; who completed the form; the participants, workers and witnesses involved, and contact details for anyone not already in your records. The Rules require names and contact details of the people involved and the person making the record.
02Severity rating
Low, medium, high or critical, so you know how fast to respond and who to tell. Severity and reportability are separate questions - a critical incident may be reportable, but you still work that out in the triage section.
03What happened
A factual account in plain language: what led up to it, what occurred, what the participant said or showed, and what evidence is attached. Facts, not opinions or blame.
04Immediate actions and safeguarding checklist
First aid, emergency services, family or nominee told, an advocate offered, workers stood down if needed, the area made safe, evidence preserved and management notified - each ticked with a time and a name.
05Injury, harm and who was informed
Any injury or distress, the first aid or medical care given, and whether the participant and their family or representative were told.
06Reportability triage
When your business first became aware (the clock starts here), the six reportable categories to tick, and the Commission notification details: the 24-hour notification, the 5 Day Form, and any final report the Commission asks for.
07Management incident assessment
The four questions the Rules require for every incident: could it have been prevented, was it managed and resolved well, what further action is needed, and does anyone else need to be told - plus the participant’s views and involvement in the review.
08Follow-up and sign-off
Follow-up actions, the link to your quality improvement plan, the register reference, who reviewed it and when, and signatures from the person who completed the form and from management.
The template
Pre-fill your details (optional)
Add your details and they fill straight into the form below and the Word download. Nothing is saved or sent anywhere - it stays in your browser.
The form
DownloadIncident Report Form
[your business or your full name] · ABN [your ABN] · Version 1.0 · Effective [date]
Use this form to record any incident that happens while supports are being delivered. Complete it as soon as possible while details are fresh, then give it to [your name] ([your email], [your phone]).
Fill in: Add your after-hours incident contact and a backup contact here (name and phone), so workers know exactly who to call straight away for a serious incident, including at night, on weekends and on public holidays.
Make sure everyone is safe first
Before filling in this form, take any steps needed to make the situation safe and arrange first aid or medical help. Recording the incident comes after people are safe.
Incident details
Incident register reference # (enter once logged in the Incident Register): ________________
Fill in: The reference line above describes the paper loop: log the incident in the Incident Register, then copy its reference number back onto this form. If you keep your register digitally (for example in the Bluetail CRM), the reference number is assigned automatically when the incident is logged and this form and the register row are the same record, so nothing needs copying across - keep this line only if you use the form on paper.
Date and time of incident: ________________
Date and time this form completed: ________________
Location: ________________
Person completing this form: ________________
Participant(s) involved: ________________
Worker(s) involved: ________________
Witnesses (if any): ________________
Contact details for participants and workers already held in [your business or your full name]'s records do not need to be repeated here. Record contact details below for any witness or other person whose details [your business or your full name] does not already hold.
Contact details for any other person or witness: ________________
Severity rating
Rate how serious this incident was. The rating helps decide how quickly to respond, who needs to be told, and how closely to follow up. If in doubt, rate it higher.
- Low - no injury or harm; minor near miss; no lasting impact
- Medium - minor injury or harm, or first aid given; some distress; could have been worse
- High - injury or harm needing medical attention; significant distress; or a near miss that could have caused serious harm
- Critical - death, serious injury, abuse, neglect, assault or other serious harm (this may be a reportable incident - complete the reportability triage below)
Severity rating (Low / Medium / High / Critical): ________________
What happened
Description of what happened
Describe the facts in plain language - what led up to it, what occurred, and who was present. Stick to what you saw and heard, not opinions or assumptions.
What happened, in the worker's own words: ________________
What the participant said or showed: ________________
What records, photos or evidence are attached: ________________
Immediate actions taken
Record what was done straight away to keep people safe and respond to the situation.
: ________________
: ________________
Immediate safeguarding checklist
Tick each step that was taken (or note "not needed" and why). Make sure people are safe and the situation is contained before completing the rest of this form.
| Safeguarding step | Done? (Y/N / N/A) | Time | By whom / notes |
| First aid / medical care provided or arranged (ambulance / doctor) | |||
| Emergency services / police called (if a crime or serious risk) | |||
| Family, nominee or emergency contact notified | |||
| Advocate / support person offered or involved | |||
| Worker(s) involved stood down or reassigned (if needed) | |||
| Environment / area made safe (hazard removed, equipment isolated) | |||
| Evidence preserved (scene, items, records, photos as appropriate) | |||
| [your name] (management) notified |
Any injury or harm, and first aid given
Note any physical injury, distress or other harm, and any first aid or medical care provided or arranged.
Injury or harm: ________________
First aid / medical care given: ________________
Was an ambulance or doctor needed? (Yes/No - details): ________________
Was the participant and/or their family or representative informed?
Who was told, and when: ________________
How they responded (if relevant): ________________
Reportability triage
Some incidents must be reported to the NDIS Quality and Safeguards Commission. A reportable incident is one that happens in connection with the supports [your business or your full name] provides and falls into one of the categories below. The timeframe clock starts when any worker first becomes aware of the incident, including over weekends and public holidays - record that moment first.
Date and time [your business or your full name] first became aware of this incident: ________________
Who became aware: ________________
Tick any category that applies. If in doubt, tick it and treat the incident as possibly reportable - it is better to check than to miss a report.
| Reportable category | Applies? (tick) | Notification timeframe |
| Death of a person with disability | Within 24 hours of becoming aware | |
| Serious injury of a person with disability | Within 24 hours of becoming aware | |
| Abuse or neglect of a person with disability | Within 24 hours of becoming aware | |
| Unlawful sexual or physical contact with, or assault of, a person with disability | Within 24 hours of becoming aware | |
| Sexual misconduct against, or in the presence of, a person with disability | Within 24 hours of becoming aware | |
| Use of a restrictive practice that was not authorised as required by the relevant State or Territory, or was not used in accordance with the participant's behaviour support plan | Within 5 business days of becoming aware (within 24 hours if it resulted in harm) | |
| Not a reportable incident (record and manage internally) | N/A |
Fill in: Name the person or role responsible for making NDIS Commission portal notifications, and a backup for when they are away. State where you save portal references and screenshots (for example: in the Bluetail CRM against the incident record).
Notifications are made through the NDIS Commission Portal. For incidents first notified within 24 hours, additional information (the 5 Day Form) must generally be provided to the Commission within 5 business days of [your business or your full name] becoming aware of the incident - measured from when [your business or your full name] first became aware, not from the 24-hour notification. For an unauthorised restrictive practice that has not caused harm, the 5 Day Form is the initial notification. The Commission may also require further information or a final report within the timeframe it specifies. The NDIS Commission can be reached on 1800 035 544.
Is this a reportable incident? (Yes/No): ________________
If yes, which category/categories apply: ________________
If yes, applicable notification timeframe (24 hours / 5 business days of becoming aware): ________________
Who notified the NDIS Commission: ________________
Date/time the NDIS Commission was notified + portal reference: ________________
Date 5 Day Form / additional information provided to the Commission (if required) + portal reference: ________________
Final report requested by the Commission? (Yes/No): ________________
If yes, due date / date submitted + portal reference: ________________
Any directions or further requirements from the Commission: ________________
Management incident assessment
Every incident is assessed by management, whether or not it is reportable. Record the answers here.
Could this incident have been prevented? (Yes / No / Unclear - details): ________________
Was the incident appropriately managed and resolved? (Yes / No - details): ________________
Further corrective or remedial action required: ________________
Does any other person or body need to be notified? (Yes / No - who, and when they were told): ________________
Participant's views and involvement in reviewing and resolving the incident (or the reason they could not be involved): ________________
Follow-up
Record what will be done to support the people affected, prevent a recurrence, and complete any reporting. [your business or your full name] management is responsible for reviewing every incident.
Follow-up actions: ________________
: ________________
Preventive action / continuous-improvement entry (link to Quality Improvement Plan): ________________
Logged in Incident Register? (Y/N + reference #): ________________
Review completed by: ________________
Date review completed: ________________
Status (open / closed): ________________
Date: ________________
Incident records, including this form, are kept securely for at least 7 years from the date the record is made.
This template is general information to help you get started, not legal advice. Tailor the highlighted prompts to how your business actually operates, train your workers in it, and obtain advice if you are unsure how the Incident Management Rules apply to your services.
When the NDIS Commission must be told
For registered providers, six kinds of incident are reportable when they happen, or are alleged to have happened, in connection with your supports: a death, a serious injury, abuse or neglect, unlawful sexual or physical contact or assault, sexual misconduct, and the unauthorised use of a restrictive practice. Every timeframe runs from when your business first became aware - which is why the form asks for that moment first.
| Incident | What to submit, and when |
|---|---|
| Death, serious injury, abuse or neglect, unlawful contact or assault, sexual misconduct | Notify within 24 hours, then additional information (the 5 Day Form) within 5 business days of becoming aware |
| Unauthorised restrictive practice that caused harm | Notify within 24 hours, then the 5 Day Form within 5 business days |
| Unauthorised restrictive practice that did not cause harm | The 5 Day Form within 5 business days - it is the initial notification |
The Commission may also ask for further information or a final report, within the timeframe it specifies. Notifications are made through the NDIS Commission Portal. If anyone is in immediate danger, call 000 first - reporting never replaces getting urgent help or contacting police where a crime may have occurred. The full process sits in your policy: see our free NDIS incident management policy template.
Filling it in well
- Safety first, paperwork second. Make everyone safe and get help before writing anything down.
- Record when you found out, not just when it happened.A worker may hear about something days later. The Commission’s clock starts at awareness, so that time needs to be on the form.
- Write what you saw and heard.Plain language, in order, without guessing at causes or assigning blame. Use the participant’s own words where you can.
- Don’t wait for proof. An allegation or suspicion is recorded and assessed the same way as a confirmed incident.
- Involve the participant. Ask for their views on what happened and how it was handled, keep them informed, and offer an advocate or support person. If they could not be involved, record why.
- If it might be a crime, protect the police investigation. Preserve evidence where it is safe to do so, and do not question people in a way that could interfere with it.
- Close the loop. Match the form to your incident register with the same reference number, finish the follow-up actions, and only then mark it closed.
What an auditor looks for in completed forms
Expect an auditor to sample real incident records, not just read the blank form. They will generally check that forms are filled in rather than left half-done; that the awareness time is recorded and any Commission notification met its timeframe; that the reportable decision is written down, including the reasons when an incident was not reportable; that the management assessment was done and the participant’s views were sought; that follow-up actions were completed; and that the form, the register and your policy all tell the same story.
Frequently asked questions
Do I need an incident report form if I already have an incident management policy?
Yes. The policy says what happens when something goes wrong; the report form is where each incident is actually recorded. The NDIS (Incident Management and Reportable Incidents) Rules 2018 set out what an incident record must contain, and an auditor will usually ask to see completed forms, not just the blank template. Most providers use a report form for the detail and a register for the one-line overview, linked by the same reference number.
Who should fill in the form?
The worker who saw the incident, was told about it, or first became aware of it - as soon as everyone is safe, and the same day wherever possible. Management then completes the reportability triage, the assessment and the follow-up sections. If you are a sole trader, you do both parts yourself.
Does every incident need a form, or only reportable ones?
Every incident. That includes near misses and alleged incidents, not just confirmed harm. Only a smaller set of serious incidents must also be notified to the NDIS Commission, but all of them are recorded and assessed in your own system. Where you decide an incident is not reportable, write down why - that reasoning is part of the evidence.
Can I keep incident reports digitally instead of on paper?
Yes, as long as the digital record captures the same information, is kept securely and can be produced when needed. The Bluetail CRM, for example, gives workers a no-login link to complete the report on their phone and keeps it on the incident register automatically. Paper works too - what matters is that the record is complete and kept.
How long do I have to keep incident reports?
The Rules require incident records to be kept for 7 years from the date the record is made. Keep them securely and confidentially, in line with your records and privacy policies.
Is this form enough to pass an audit?
No template can be. An auditor looks at whether your incident management system genuinely works - whether workers know what to do, whether forms are actually completed, whether reportable incidents were notified on time and whether follow-up actions were closed out. The form helps you capture the right information; using it consistently is what counts.
Need the matching register, policy and the rest?
This incident report form is one of the 82 editable Word documents in the Bluetail registration pack - which also includes the matching Incident Register, the Incident Management Policy, an Open Disclosure Procedure and a participant guide to raising incidents and complaints, all pre-filled with your business name and logo. The pack is designed to support common registration and audit-preparation tasks for small providers - the documents and evidence you actually need will depend on your registration groups, audit pathway, business structure and services, and the pack does not guarantee registration, audit conformity or legal compliance. Preview every document free, then unlock all 82 for $65 once.
See the $65 packThis page is general information, not legal advice. Bluetail is not affiliated with, endorsed by, or connected to the NDIS Quality and Safeguards Commission or the NDIA. For advice on how the NDIS (Incident Management and Reportable Incidents) Rules 2018 apply to your services, speak to a qualified professional.