Restaurant Incident Report Form & Template (Customer Incidents)
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A restaurant customer incident report documents a customer fall, allergic reaction, or foreign object complaint with the customer's contact details, witness statements, and photos: the documentation your liability insurer needs to evaluate a claim.
A customer fall, an allergic reaction, or a foreign object in a dish: this template lets you document the incident immediately, with the customer's and witnesses' contact details for your liability claim.
What this template includes
Every field below is part of the free template and the mobile version; nothing is locked behind a paywall for filling out a single report.
- Report number and date/time of the incident
- Location or site
- Reporter's name and role
- Severity (minor, moderate, or critical)
- Person(s) involved: name, role, contact
- Witness(es): name, phone
- Description of events
- Immediate action taken and root cause (if known)
- Up to 3 timestamped photographs
- Reporter signature
- Witness or supervisor signature
Sample completed report
What this template looks like filled in. Every name, place and time below is invented.
- Report number
- RST-2026-0019
- Date and time of incident
- Saturday, June 20, 2026, 7:35 p.m.
- Location
- Dining room, beside table 12
- Reported by
- S. Kim, shift manager
- Severity
- Minor
- Person involved
- Guest, adult (contact details kept on file)
- Witnesses
- P. Duarte, server; the guest's companion
- Injury and care given
- Guest reported a sore right ankle after slipping without falling; ice pack given; declined medical attention
- Photos
- 3 timestamped photos: the spill, the floor after cleanup, the sign placement
- Signatures
- Shift manager and server
Description of events
At 7:35 p.m., a guest walking back from the restroom slipped on a spilled drink beside table 12 and caught herself on a chair; she did not fall. She said her right ankle hurt. I offered an ice pack and to call for medical help; she accepted the ice and declined medical attention. The drink had been knocked over at table 12 about three minutes earlier, and P. Duarte had gone for a mop; no wet-floor sign had been put out yet. The spill was mopped and dried by 7:38 p.m. I recorded the guest's contact details, photographed the area, and the guest left at 8:30 p.m. walking normally. Action: a wet-floor sign now goes down before anyone leaves a spill to get a mop.
More filled-in reports, one per kind of incident: 10 incident report examples.
How to file a defensible restaurants report
- 1
Document it before the customer leaves
Get the report started while the customer is still on-site if possible: details and contact information are much easier to gather then than after the fact.
- 2
Get the customer's and any witness's contact details
Record names and phone numbers of the customer and any other diners or staff who saw what happened.
- 3
Photograph the hazard or item
Photograph the wet floor, the food item, or whatever's relevant: timestamped evidence matters if a claim follows weeks later.
- 4
File it for your insurer's file
Keep the signed report on hand so it's ready the moment your liability insurer asks for it, not reconstructed from memory.
Common use cases
- Customer fall on a wet floor
- Allergic reaction
- Foreign object in food
- Suspected food poisoning
Frequently asked questions
Why document even a minor incident?
An undocumented incident can turn into a claim months later with no evidence on your side. A timestamped, signed report protects your business in case of a dispute.
How do you write a restaurant incident report?
Right after the incident, write the date, time and exact spot, what happened in order, the customer's own account in their words, what staff did, witnesses with their contact details, and photos of the area, such as a wet floor or a broken chair. Stick to facts, don't guess at fault, and have the manager on duty sign it.
Do restaurants have to report customer injuries to OSHA?
No. OSHA's injury records and reporting rules cover employees, not customers. A customer injury is documented for your insurer and your own records, following your liability policy's notice terms. A staff injury is different and may belong on the OSHA 300 log.
For the federal recordkeeping rules referenced above, see OSHA's recordkeeping requirements.
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