Free Work Injury Report

When making a formal report regarding a workplace accident, injury or illness, make sure you include all the basic information needed to comply with OSHA guidelines and requirements. Your letter or memorandum should include all the basic information, including the injured persons' name(s) and address(es), the department they work in, their ID number, phone number and extension.

Make sure you are clear about the details of the event. You should be as specific as possible when indicating the time and date of the incident, the events leading up to the incident and any contributing factors to the incident. In the event of a lawsuit or dispute in the future regarding the incident, this report could be used as the primary record of the event. For this reason, you should include as many details as you can recall.

If you are an employee completing this form you should indicate the amount of time off you required due to this incident.

A Work Injury Report should be completed immediately following the incident or as soon thereafter as possible to comply with OSHA safety requirements. An employer is required to complete a detailed report of any recordable incident within 7 calendar days of learning of the event.

Examples of recordable events include any event that results in any of the following:

• Results in the death of an employee.
  
• Loss of consciousness.
  
• Employee Misses Work.
  
• Employee's limited ability to work.
  
• Employee is transferred to a different position as a result of the incident.
  
• Addition Medical treatment is needed beyond first aid.

While the employer is required to complete a report to comply with OSHA safety requirements, the employee directly involved in the incident will typically provide the information. This report provides a detailed description of the event including the date and time, events leading up to the incident, a description of the incident, the resulting injuries and any other information the reporter elects to include.

In order to comply with OSHA safety guidelines, Public Law 91-596 and 29 CFR 1904, an employer must retain the report regarding an incident for a minimum of 5 years following the year the incident occurred.