TEMPLATE

Delaware incident report template

ReportDraft Safety from $12 a month. 14-day free trial with your first report and up to 5 template downloads. Card required, nothing charged today, cancel anytime. Need just one? One incident report for $19, no subscription.

Your Delaware incident report has 7 rules to meet. ReportDraft puts every one on your checklist and checks your draft before you sign.

  • A record of every work injury
  • Any injury: the written report to the Department within 10 days
  • The employee's copy of the report, with the summary of the law

An incident report template set up for Delaware, with fields for the nature of the employer's business, report to the Department of Labor (date), copy of the report given to the employee (date) and supplemental report when the disability ends (date). In Word and PDF.

See a free preview filled from sample notes

REPORTDRAFT.COM
Delaware Incident report Template
Company or organization
Site address or location
Date of the incident
Type of incident
Completed by
Nature of the employer's business
Report to the Department of Labor (date)
Copy of the report given to the employee (date)
Download in Word or PDFIncluded with ReportDraft Safety and its free trial.

Delaware 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 under the Workers' Compensation Act keeps a record of all injuries, fatal or otherwise, that employees receive in the course of their employment19 Del. C. 2313 (a)
  • Within 10 days after learning of an accident resulting in personal injury, the employer makes a written report to the Department of Labor, in duplicate, on the Department's forms, with no minimum lost time or treatment19 Del. C. 2313 (a)
  • The employer gives the employee a copy of the report when it is completed, and the employee's copy carries the Department's summary of the law19 Del. C. 2313 (a), (b)
  • The report gives the name and nature of the employer's business, the location of the establishment or place of work, the injured employee's name, age, sex and occupation, and the time, nature and cause of the injury19 Del. C. 2313 (b)
  • When the injured employee's disability ends, the employer makes a supplemental report to the Department19 Del. C. 2313 (a)
  • An employer that refuses or neglects to make a required report is fined 100 to 250 dollars for each offense, assessed by the Industrial Accident Board after notice and a hearing; the fine can fall on the insurance carrier when the carrier refused to report an injury it knew of and the employer did not19 Del. C. 2313 (c)
  • The reports are not evidence against the employer in any proceeding and are only for the Department's information19 Del. C. 2313 (d)
  • Unless the employer knew of the injury, no compensation is due until the employee, or someone on their behalf, gives the employer notice; notice is due within 90 days after the accident19 Del. C. 2341

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 Delaware incident report requirements.