District of Columbia incident report template

District of Columbia rules for this report

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

• Within 10 days of any injury or death, or of learning of an occupational disease, the employer sends a written Report of Injury to the Office of Workers' Compensation (the Code says 10 days; the rule says ten working days, so 10 calendar days meets both); a report mailed within the time limit compliesD.C. Code 32-1532 (a), (d) · 7 DCMR 203.1, 203.5
• The Report of Injury gives the employer's name, address, phone number and business; the employee's name, address, phone number and occupation; the date, time and place of the injury; its nature and cause; whether it is expected to result in lost time; the name of any known witness and other relevant circumstances; and the name and address of the employer's insurer7 DCMR 203.4
• At the same time as the report, the employer sends the employee (or next of kin) by certified mail, return receipt requested, a statement of the employee's rights and obligations, including the right to file a claim within one year of the injury or deathD.C. Code 32-1532 (a) · 7 DCMR 205.1
• Each employer keeps a record of all injuries to its employees, open to the Office's inspection during business hours at the place of business; a record is adequate if it holds the Report of Injury's information7 DCMR 204.1 to 204.3
• Employers conspicuously post information on the Act and their insurance coverage, saying at least that an injured employee may be entitled to lost wages and medical expenses, must notify the employer of any injury and must file a claim, with the Office's current address and phone number7 DCMR 205.4, 205.5
• Failing or refusing to send a required report brings a civil penalty of up to 1,000 dollars for each failure, and the one-year time limit for the employee's claim does not start to run until the report is filedD.C. Code 32-1532 (e), (f)
• A report is not evidence of any fact stated in it in a proceeding about the injury or deathD.C. Code 32-1532 (c)
• The employee gives written Notice of Injury to the Office and the employer within 30 days of the injury or of becoming aware of its link to the work, signed, with the date, approximate time and place, nature and cause, known witnesses, and whether medical treatment was obtained and from whomD.C. Code 32-1513 · 7 DCMR 206.1, 206.2

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 District of Columbia incident report requirements.