Colorado incident report template

Colorado rules for this report

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

• Within ten days of notice or knowledge, the employer reports any work-related injury, illness or exposure to an injurious substance to its workers' compensation insurer; an employer that does not may face penalties or other sanctions7 CCR 1101-3, Rule 5-2 (A) (eff. 2026-07-15)
• A fatality, or three or more employees injured in the same accident, needs a First Report of Injury with the Division within three days of notice to the insurer or self-insured employer; the insurer or administrator may file it for the employer7 CCR 1101-3, Rule 5-2 (B) (1)
• A First Report of Injury is filed within ten days of the employer's notice or knowledge when an injury or occupational disease causes more than three shifts or calendar days of lost time, causes permanent physical impairment, first needs scheduled treatment more than 180 days after the employer's notice, or is a listed occupational disease (chronic respiratory disease, cancer, pneumoconiosis, nervous system diseases, blood-borne infectious diseases), and within ten days after any claim is denied7 CCR 1101-3, Rule 5-2 (B) (2), (3) · Division of Workers' Compensation: Reporting Injuries
• When an injured worker who first survives dies later, the employer files a new First Report of Injury for the date of death, so there are two claims; a death of unclear cause is still reported to the insurer to investigateDivision of Workers' Compensation: Reporting Injuries
• The insurer states whether it admits or contests liability within 20 days after the First Report is filed (or should have been filed), and a contest is filed electronically7 CCR 1101-3, Rule 5-2 (C) · Division of Workers' Compensation: Reporting Injuries
• Each insurer sends the Division a monthly summary of the smaller injuries (no more than three days or shifts lost, no permanent impairment, no fatality) and of exposures to injurious substances, energy or atmospheres where the employer's required protective methods or equipment failed, were misused or were not used7 CCR 1101-3, Rule 5-2 (F)
• The injured worker tells the employer about the injury in writing within 10 working days; a later report is still made as soon as possible, but missing the 10 working days may bring a penalty against the worker's benefits; workers may also file the Worker's Claim for Compensation (WC 15) with the DivisionDivision of Workers' Compensation: Reporting Injuries

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 Colorado incident report requirements.