California incident report template

California rules for this report

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

• Every employer reports any serious injury or illness, or death, of an employee occurring in a place of employment or in connection with any employment to Cal/OSHA immediately, meaning as soon as practically possible but not longer than 8 hours after the employer knows or with diligent inquiry would have known (no longer than 24 hours if the employer can show exigent circumstances), by telephone or through the Division's online mechanism (by telephone or email until one is available)Cal. Code Regs., tit. 8, s. 342 (a)
• The report gives, if available: the time and date of the accident; the employer's name, address and telephone number; the name and job title or badge number of the person reporting; the address of the site; the name of the person to contact at the site; the name and address of the injured employee(s); the nature of the injury; where the injured employee(s) were moved to; other law enforcement agencies present; and a description of the accident and whether the scene or instrumentality has been alteredCal. Code Regs., tit. 8, s. 342 (c)
• A serious injury or illness is one occurring in a place of employment or in connection with employment that requires inpatient hospitalization for other than medical observation or diagnostic testing, or in which an employee suffers an amputation, the loss of an eye, or any serious degree of permanent disfigurement; an accident on a public street or highway is excluded unless it occurred in a construction zoneCal. Code Regs., tit. 8, s. 330 (h)
• California's reporting requirement for a serious occupational injury, illness or death has no 30-day time frame between the incident and the death, unlike the federal ruleCal/OSHA, Differences: Cal/OSHA and Fed/OSHA Recordkeeping
• When a state, county or local fire or police agency is called to an accident involving an employee in which a serious injury, illness or death occurs, the responding agency notifies the nearest Cal/OSHA office by telephone immediately; this is in addition to the employer's own reportCal. Code Regs., tit. 8, s. 342 (b), (d)
• For each recordable injury or illness, the employer completes a Cal/OSHA Form 301 Injury and Illness Incident Report, or an equivalent form, within seven calendar days of receiving information that it occurred, and keeps it on file for 5 years following the year to which it pertainsCal. Code Regs., tit. 8, s. 14300.29 (b) (2), (3) · Cal/OSHA Form 301 (Appendix C)
• An equivalent form has the same information, is as readable and understandable to a person not familiar with it, and is completed using the same instructions as the Cal/OSHA form it replaces; records may be kept on a computer that can produce equivalent forms when neededCal. Code Regs., tit. 8, s. 14300.29 (b) (4), (5)

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 12, 2026. Read the full California incident report requirements.