Workers Compensation-Incident Report

February 3, 2015

Having an Incident Report in Place

Sources California State University WC Guide for Supervisors & Managers, OSHA

Do you have a plan in place for your business if an employee becomes ill or injured while at work?  A Supervisor’s Injury and Illness Incident Report is a general requirement under OSHA regulations.  Partial Exemption is given if your company had ten (10) or fewer employees at all times during the last calendar year, you do not need to keep OSHA injury and illness records unless OSHA or the BLS informs you in writing that you must keep records under § 1904.41 or § 1904.42.  The California Occupational Safety and Health Administration, or Cal/OSHA, requires employers to report EVERY case involving fatalities, hospitalizations, amputations and losses of an eye as a result of work-related incidents as required by OSHA regulations 1904.39.  If there is a fatality of any employee as a result of a work-related incident, you must report to OSHA immediately within eight (8) hours.

Below are some guidelines to consider while creating your Supervisor’s Injury and Illness Report.

1. Arrange medical care for the injured employee.

  • In an emergency situation
  • First Aid
  • Injuries/Illness beyond First Aid

2.  Your responsibility as the Supervisor

  • As required by OSHA within eight (8) hours of your knowledge of the injury/illness complete the Supervisor’s Injury and Illness Incident Report and contact OSHA if there is a fatality or hospitalization of any employee.
  • Your role is to look into the incident by completing the Supervisor’s Injury and Illness Incident Report with the employee.  First aids must also be reported on this form.
  • Do not give this form to the employee to complete.  It is the supervisor’s responsibility to address concerns, if any, surrounding the injury with the employee. Addressing safety and training concerns are critical in preventing injuries.
  • Forwarding copies to the appropriate departments (including OSHA)

3.  Your role with the injured/ill worker

The Employee will generally need to complete two forms and return to appropriate department(s):

  • Employee’s Report of Work Injury/Illness
  • Employee’s Claim for Workers’ Compensation

4.  Accident Investigation

Set up an individual or team to investigate accidents which would include:

  • Interviewing injured personnel and witnesses.
  • Examining the injured employee’s work area for causative factors
  • Reviewing established procedures to ensure they are adequate and were followed.
  • Reviewing training records of affected employee and determine all contributing causes of the accident.
  • Taking corrective actions to prevent accident/exposure from reoccurring.
  • Recording and reporting all findings and actions taken.

5.  Contact with the injured/ill employee

  • Set up procedures about whether to contact the employee when they are off from work

6.  Returning to Work

Set up procedures of employee returning to work regarding the following areas:

  • work restrictions, if any.
  • Be open to discuss possible “modified work” or “alternative work” when the employee is able to return.
  • If feasible, arrange to have equipment needed or other temporary accommodations in place.


We hope you have found this information useful. Check in with us again as we will expand on this subject.  If you would like to make suggestions for future topics please contact us.

The Armstrong Company Insurance Consultants  (License #0440075)