Florida incident report template

Florida rules for this report

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

• Employers record all industrial injuries and diseases. For a first aid case that need not be reported to the claim administrator, the record holds the employee's name, an identifying number, the date and time, the employee's occupation, who the injury was reported to and when, a description of the accident including its cause, the injury and body part affected, and the location if not the employer's addressFla. Admin. Code 69L-56.401 (1) (a)
• Every case except first aid (medical only, lost time or death) is reported to the employer's claim administrator on Form DFS-F2-DWC-1 within 7 days after the employer learns of it, without waiting for the employee's signature; a first aid case that later needs medical care or time off is reported within 7 days of learning of the changeFla. Admin. Code 69L-56.401 (2) (a), (b) · Fla. Stat. 440.185 (2) (2026)
• When the employer sends the DWC-1 it gives a copy to the employee or the employee's estate; the report states the employer's name, address and business, the employee's details and occupation, the cause and nature of the injury, and the year, month, day, hour and place it occurredFla. Stat. 440.185 (2) (a) to (d) · Fla. Admin. Code 69L-56.401 (2) (c)
• If an injury or illness results in death, besides the 7-day report the employer notifies the Division of Workers' Compensation by telephone or other means within 24 hours of learning of the death (1-800-219-8953, fax 850-413-1979, or the Division's fatality report email)Fla. Admin. Code 69L-56.401 (2) (d)
• An employer that fails to notify the carrier of an injury within the 7 days on the prescribed form or by letter can be fined up to 500 dollars for each failure, paid by the employer and not the carrierFla. Stat. 440.185 (8)
• An injured employee tells the employer within 30 days after the injury or its first manifestation; missing the deadline bars a claim unless the employer knew, the cause needed a medical opinion, the employer did not post the required notice, or exceptional circumstances applyFla. Stat. 440.185 (1)
• When an employee reports an injury, the employer or carrier gives the employee written notice of the Employee Assistance and Ombudsman Office's services and contacts, and the carrier mails the injured worker the Department's informational brochure within 3 business days of learning of the injuryFla. Stat. 440.185 (3), (10)
• Unless the parties agree, the injury reports are not evidence of any fact stated in them in a proceeding about the claim, except qualified medical reportsFla. Stat. 440.185 (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 15, 2026. Read the full Florida incident report requirements.