---
title: Retail Store Customer Accident Report Form Template | Paperform
description: Professional retail customer accident report form with liability assessment, video footage timestamps, injury documentation, and insurance claim details. Protect your business and document incidents thoroughly.
url: "https://paperform.co/templates/retail-store-customer-accident-report"
type: static
generatedAt: "2026-03-28T00:45:04.383Z"
---

[← Back to free form templates](/templates/)    ![Retail Store Customer Accident Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/retail-store-customer-accident-report.png)
    [Preview](https://_preview.paperform.co/ai-template/retail-store-customer-accident-report) [Use this template for free](/create?ai-template=retail-store-customer-accident-report)    [Reporting & Incident Forms](/templates/category/reporting/)[Legal & Compliance Forms](/templates/category/legal/) [Business](/templates/industry/business/)[Insurance](/templates/industry/insurance/)[Retail](/templates/industry/retail/) [Small Business Owner](/templates/role/small-business-owner/)[Shop Owner](/templates/role/shop-owner/)[Office Manager](/templates/role/office-manager/)[Manager](/templates/role/manager/)     About this free form template
When a customer is injured in your retail store, quick and thorough documentation is essential for both customer care and liability protection. This **retail store customer accident report template** helps you capture every critical detail while the incident is fresh, from witness statements to video footage timestamps.

This form is designed for retail managers, store supervisors, and loss prevention teams who need to document customer accidents professionally and completely. Whether it's a slip, trip, fall, or other in-store incident, you'll gather the information your insurance carrier, legal team, and risk management department need to assess liability and process claims efficiently.

The template walks your team through structured sections covering incident details, customer information, injury assessment, environmental conditions, witness accounts, and video surveillance documentation. Conditional logic ensures relevant follow-up questions appear based on injury severity and circumstances, while maintaining a clear audit trail.

**Paperform** makes this process straightforward even during stressful moments. The doc-style editor lets you customize questions for your specific store layout, hazards, and protocols, while the mobile-friendly design means staff can complete reports on tablets or phones right from the sales floor.

Once submitted, use **Stepper** to automate your incident response workflow—send immediate notifications to your insurance broker and legal team, create tasks for facility managers to address hazards, update your risk management database, and trigger follow-up protocols. You can also integrate with your existing incident tracking systems, Slack for urgent alerts, or Google Drive to organize supporting documentation like photos and video clips.

For retailers managing multiple locations, this template ensures consistent accident documentation across all stores, supporting your risk mitigation strategy and protecting your business when incidents occur.
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