Alabama incident report template

Alabama rules for this report

These rules are about how and when you report, not the template's fields. Check them before you deliver.

• An employer keeps a record of all injuries, fatal or otherwise, that its employees receive arising out of and in the course of their employment and for which compensation is claimed or paidCode of Ala. 25-5-4
• Within 15 days after the injury and the employer's knowledge of it, a report goes to the Department on its approved form: the WCC 2 Employer's First Report of Injury, for every injury for which compensation is claimed or paid, including deaths, permanent disabilities and temporary disabilities of more than three daysCode of Ala. 25-5-4 · Ala. Admin. Code 480-5-1-.01 (1)
• The insurer or self-insured employer files a WCC 3 Supplementary Report within 10 days after the first payment of compensation, after 30 days of nonpayment once the employer knows of a claim, or after payments stop, and a WCC 4 Final Report within 10 days (30 at most) after the final payment; incomplete or illegible reports are not acceptedAla. Admin. Code 480-5-1-.01 (2), (3), (5)
• The injured employee or a representative gives the employer written notice of the accident within five days; without it, medical fees and accrued compensation are lost unless incapacity, fraud, deceit or equally good reason prevented notice, and no compensation is payable at all without written notice within 90 daysCode of Ala. 25-5-78
• The notice is served personally or by registered or certified mail and follows the statutory form: who was injured, where they worked, their job, under whose superintendency, the date and hour, where the employee now is, the nature of the injury as far as known, signed with an address and datedCode of Ala. 25-5-79
• A claim for an injury not caused by cumulative physical stress is barred unless, within two years after the accident, the parties agree on compensation or one of them files a verified complaint; payments of compensation restart the period from the last paymentCode of Ala. 25-5-80

What is in it

• What happenedWhat the person was doing just before the incident, with the tools, equipment or material used, then how the incident happened, in the order it happened.
• Injury or illness and treatmentThe part of the body affected and how, the object or substance that directly caused harm, and the first aid or medical treatment given and where.
• Damage to property, equipment or the environmentWhat was damaged, spilled or released, and how much, as the notes give it.
• Immediate actions takenWhat was done right away: first aid, emergency calls, the area made safe, equipment stopped or tagged out, and who was notified.
• CausesThe immediate cause and any underlying causes the notes identify: equipment, procedures, training, work conditions, supervision. Only what the notes support.
• Witness statementsName, Role, What they saw or said
• Corrective actionsAction, Responsible, Due, Status

Rules last reviewed October 15, 2026. Read the full Alabama incident report requirements.