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Get OSHA Employee's Report of Injury Form

_______ Age: This employee works: ‰ Regular full time ‰ Regular part time ‰ Seasonal ‰ Temporary Months with this employer Months doing this job: Step 2: Describe the incident Exact location of the incident: Exact time: What part of employee’s workday? ‰ Entering or leaving work ‰ Doing normal work activities ‰ During meal period ‰ During break ‰ Working overtime ‰ Other___________________ Names of witnesses (if any): 3 Written witness statements: Photographs: Number of attac.

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Injury reporting form FAQ

Near miss form Related content

  • Employee's Report of Injury Form - OSHA

    Instructions: Employees shall use this form to report all work related injuries...

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  • Employee's Report of Injury Form - OSHA

    Instructions: Employees shall use this form to report all work related injuries...

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  • Rule by Chapter - L&I - Access Washington

    Requirements for employers to record and report work-related fatalities, injuries...

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