Safety & Compliance · Intermediate
Complete as soon as possible after the incident. Be factual and specific. Determine if the injury is OSHA recordable (medical treatment beyond first aid, lost work days, restricted duty, or loss of consciousness).
A structured incident report form for US employers, supporting OSHA recordkeeping requirements under 29 CFR 1904. Captures incident details, injured employee information, witness statements, immediate response actions, root cause analysis, and corrective actions — providing the documentation needed for OSHA 300 Log entries and workers' compensation claims.
OSHA requires employers to record work-related injuries and illnesses that meet specific criteria. This form captures all the information needed for Form 300, Form 301, and your internal safety investigation process.
This checklist template is provided as a general-purpose resource and is not tailored to the regulatory requirements of any specific country, region, or jurisdiction. It is the responsibility of each organisation to review and adapt this template to ensure compliance with all applicable local laws and regulations. Miratag does not accept liability for any inaccuracies or omissions, or for any actions taken based on this template.
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