Alaska incident report template

Alaska rules for this report

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

• A work accident that kills an employee or causes an in-patient hospitalization, loss of an eye or an amputation is reported immediately, and no later than 8 hours after the employer learns of it, by telephone or in person to the nearest office of the Division of Labor Standards and Safety or on the federal toll-free number the division provides; if the employer first learns of it 8 hours to 30 days after the accident, the report is due within 8 hours of learning. The report gives the establishment, location and time, a contact person and phone number, a brief description, the number of employees killed or injured and the extent of the injuriesAS 18.60.058 (a)
• After an accident that kills one or more employees or hospitalizes two or more, equipment, material and products involved may not be moved or altered until the department clears it, unless waiting would unreasonably interfere with work or create more hazards; if they must be moved first, the employer submits a detailed investigative report to the divisionAS 18.60.058 (b)
• Alaska adopts the federal injury recordkeeping rules (29 CFR 1904) as its own standards, except the federal serious-injury reporting section, which Alaska law replaces; seasonal establishments closed at year end post the annual summary within 15 days of reopening, for 90 days or the whole season if shorter8 AAC 61.1010 (a), 61.1015
• Within 10 days of learning of an injury, death, disease or infection the employee says arose from the work, the employer files a report with the Workers' Compensation Division giving the employer's name, address and business, the employee's name, address and occupation, the cause and nature of the injury, and the date, hour and place it happened. The report is not evidence of the facts in itAS 23.30.070 (a), (c)
• If the employer or carrier knew of the injury and does not file the report, the employee's time limit for a claim does not start until it is filed, and the board may order an extra award of 20 percent of any compensation unpaid when dueAS 23.30.070 (e), (f)
• The employee gives the employer notice of the injury within 15 days, in the director's format, with name and address, the time, place, nature and cause, and a medical records release, signed; a missed notice does not bar the claim if the employer knew and was not prejudiced, the board excuses it, or no objection is raised at the first hearingAS 23.30.100

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 13, 2026. Read the full Alaska incident report requirements.