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Security and safety

Incident report

Each kind of incident asks its own questions, and an injury shows an emergency notice. Free to use with FillKite.

Live demo

Incident report

Fill it in and press the button to see how it behaves. Nothing you type is saved or sent.

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Test mode: you can try this form, but nothing you send is saved or passed on.

Your name

What is in this form

  • Your name (required)
  • Phone
  • What happened? (required)
  • Date (required)
  • Time
  • Who was hurt? (required)
  • Was first aid given?
  • What was taken? (required)
  • Did you tell the police?
  • Police reference
  • What happened? (required)

How the conditional logic works

This form shows or hides fields as people answer, so everyone sees only what matters to them.

  • A notice appears only when “What happened?” is “An injury”.
  • “Who was hurt?” appears only when “What happened?” is “An injury”.
  • “Was first aid given?” appears only when “What happened?” is “An injury”.
  • “What was taken?” appears only when “What happened?” is “A theft”.
  • “Did you tell the police?” appears only when “What happened?” is “A theft”.
  • “Police reference” appears only when “What happened?” is “A theft” and “Did you tell the police?” is “Yes”.

Use it on your site

  1. Install FillKite free from WordPress.org.
  2. Download this form with the button above.
  3. Go to FillKite → Import → From a FillKite file, choose the file and import it.

Questions

About this form

Is the incident report form free?

Yes. It works with the free FillKite plugin, and you can download it and change it as you like.

Is anything I type saved?

No. This demo runs in test mode: FillKite checks your answers like a real form, but nothing is saved and no email is sent.

How do I use this form on my site?

Install FillKite, download the form with the button on this page, then go to FillKite → Import → From a FillKite file and choose the file. After importing, open it in the builder, change anything you like and add it to a page.

Does this form use conditional logic?

Yes. 6 fields or notices show only when earlier answers call for it. A notice appears only when “What happened?” is “An injury”.

What fields does it have?

It has 11 fields: Your name, Phone, What happened?, Date, Time, Who was hurt?, Was first aid given?, What was taken? and more.

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