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An employee incident report documents a workplace issue, event, or injury concerning an employee. It describes the incident, including the date, time, and location, and the parties involved. The completed document should be given to a supervising manager or the company’s HR department for internal review and storage.
OSHA Recording Requirements
Companies with more than 10 employees must complete and store OSHA Form 300 and 301 to record all serious employee illnesses and injuries (see OSHA guideline)[1]. Some industries are exempt from this requirement. OSHA forms must be held for five years and data must be submitted yearly through the ITA.[2]
When to Use
- Accidents, injuries, and near misses
- Illnesses and medical emergencies
- Arguments and altercations
- Poor performance or behavior that merits a warning
- Being inebriated on the job
- Illegal activity and calls to the police
Sample
Full Name: [FULL NAME] Title/Role: [TITLE/ROLE]
Signature: Date: [MM/DD/YYYY]
Describe the Incident: [DESCRIBE THE INCIDENT]
Identification: ☐ Driver’s License No. [DL NUMBER] ☐ Passport No. [PASSPORT NUMBER] ☐ Other: [OTHER]
Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL] Address: [ADDRESS]
Identification: ☐ Driver’s License No. [DL NUMBER] ☐ Passport No. [PASSPORT NUMBER] ☐ Other: [OTHER]
If yes, enter the witnesses’ names and contact info:
- Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL]
- Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL]
If yes, was a report filed? ☐ Yes ☐ No
Was medical treatment provided? ☐ Yes ☐ No ☐ Refused
If yes, where was medical treatment provided? ☐ On site ☐ Hospital ☐ Other: [OTHER]