Workplace Incident Report Template

You must report specific workplace accidents to the Occupational Safety & Health Administration (OSHA). Depending on the incident, you must report within specific timeframes:

• Fatalities: Within 8 hours of finding out.
• Inpatient hospitalizations: Within 24 hours of finding out (not for observations or diagnostic testing).
• Amputations: Within 24 hours of finding out.
• Loss of an eye: Within 24 hours of finding out.

While these timeframes are required, you must report these health and safety issues promptly to encourage fast resolution.

Even if the work-related incident doesn’t require reporting to OSHA, thorough documentation is still helpful. Recording any workplace incident, no matter how small, shows due diligence and improves health and safety. Use Legal Templates’s workplace incident report template to create a comprehensive record you can refer to later if needed.

How to Report a Workplace Incident to OSHA

If you had one of these serious incidents at your workplace, you must report it to OSHA. Call the nearest OSHA Area Office to report the incident over the phone during normal business hours.

If an incident happens outside of normal business hours, call the 24-hour OSHA hotline at 1-800-321-6742. If you prefer online submission, OSHA offers an online form for work incident reporting.

Follow these steps to create a consistent process for writing workplace incident reports.

1. Name the Employees Involved

Name the involved parties. In our document editor, you can list up to three employees who were a part of the incident. Provide their name, job title, department, and contact information.

If you have time, consider contacting the employee’s emergency contact. You can find this information on their emergency contact forms or employee information form. If you don’t already have these forms from your employees, have them fill them out so you’re prepared for future emergencies.

2. Give the Workplace Incident Details

Give the date and time of the incident as close to your knowledge. Specify the type of incident, whether it was an injury, property damage, environmental issue, near miss, or vehicle accident. When you use our template, you can choose from one of these pre-written options or write your own to better describe the situation.

You should also give the location of the incident, including the property address and specific site. For example, you can give your company’s office address and specify that the incident happened in the breakroom on the third floor.

3. Describe Property Damage or Injuries

Indicate whether the employee(s) sustained an injury. If they did, specify the type of injury and affected body party. You can also explain the medical treatment provided, if applicable.

You can also clarify if there was any property damage. If there was, describe the extent of the damage and give an estimated cost.

4. Name Witnesses

Name witnesses who saw the workplace incident firsthand. List their names, phone numbers, and emails. This way, your HR department can contact them for further details.

5. Provide Investigation Details

Describe the root cause of the workplace incident. You may not be able to complete this part until an in-depth investigation, but try to provide as much context as possible. You should also name the corrective actions your team will take or has taken. This shows initiative and that you strive to prevent the issues in the future.

6. Record Final Details

Give the name of the supervisor reviewing the report. Naming them holds them accountable and ensures they can vouch for the form’s accuracy. You should also provide the date of the report for accurate recordkeeping, which you can easily do in our document editor.

Here are some tips for writing a comprehensive workplace incident report form:

• Use third-person language: Describe the unexpected events from a neutral perspective. Refrain from using emotional language.
• Always report: If you’re unsure whether the incident requires reporting, report it to be safe.
• Ask witnesses: Get information about the workplace incident from witnesses who saw it firsthand.
• Collect evidence: Attach evidence to the report, as this can determine whether the issue was caused by human error or another problem.
• Communicate: Communicate with your manager or HR representative to ensure they comply with OSHA and other legal requirements.
• Update safety guidelines: If needed, update your workplace’s safety guidelines to prevent similar incidents.

View a free sample of a workplace incident report to learn what details to include. When you’re ready, fill out your own via our workplace incident report template. Available to download as a PDF or Word file.

You only have to report a workplace incident if it results in a fatality, eye loss, amputation, or inpatient hospitalization. However, you may have to follow separate OSHA recordkeeping requirements for work incidents.

Any workplace with more than 10 employees must record certain work-related injuries and illnesses. These include the following:

• fatalities
• illnesses/injuries that lead to loss of consciousness
• conditions that lead to days away from work, restricted work, or job transfers
• injuries or illnesses that need medical treatment beyond first aid
• diagnoses of punctured eardrums, cracked teeth, or fractured bones
• diagnoses of chronic irreversible diseases and cancer

Depending on the severity, you may need to record some work-related cases involving sharp injuries, needlesticks, medical removal, tuberculosis, and hearing loss.

You can perform proper recordkeeping using OSHA’s Forms 300, 300A, and 301. OSHA requires employers to keep each record at their worksites for five years. Employers must also follow OSHA’s posting requirements to inform employees of the previous year’s illnesses and injuries.