Incident report form 2026

1. Click ‘Get Form’ to open the incident report form in the editor.
2. Begin by filling out the 'Employee & Case Information' section. Enter the employee's name, case number (assigned by Work Comp Dept.), address details, date of birth, and date hired. Indicate the employee's gender and provide the date and time of the injury or illness.
3. In the 'Information about the physician or other health care professional' section, input the name of the treating physician if known. Specify where treatment was given if it was away from the worksite, and indicate whether emergency room treatment or overnight hospitalization occurred.
4. Next, describe what the employee was doing just before the incident in detail. Include any tools or equipment involved in this activity.
5. Explain how the injury occurred by detailing specific events leading up to it. Be clear and concise for better understanding.
6. Identify the injury or illness by specifying which part of the body was affected. Avoid vague terms; be as specific as possible.
7. Finally, mention any object or substance that directly harmed the employee. If not applicable, you may leave this blank.

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