Illinois incident report template

Illinois 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 keeps accurate records of work-related deaths, injuries and illnesses, except minor injuries needing only first aid that involve no medical treatment, loss of consciousness, restriction of work or motion, or transfer to another job820 ILCS 305/6 (b)
• The employer reports to the Workers' Compensation Commission, in writing, every accidental death, injury or illness that results in the loss of more than 3 scheduled work days: a death within 2 working days, other cases between the 15th and 25th of each month, and a further report once a permanent disability is determined820 ILCS 305/6 (b) · IWCC Forms page, Accident Reporting
• Each report states the date and time of day of the injury, the nature of the employer's business, the injured person's name, address, age, sex, marital status and specific occupation, the direct cause of the injury and the nature of the accident, the character of the injury, the length of disability, wages, and compensation and medical bills paid and by whom820 ILCS 305/6 (b)
• Since June 14, 2019 the Commission requires accident reports in the IAIABC 3.1 XML (EDI) standard, filed by the employer or the insurer on its behalf, and it no longer collects Social Security numbers on themIWCC Forms page, Accident Reporting
• Filing these reports with the Commission satisfies the employer's injury reporting to other State officers under the Safety Inspection and Education Act, the Health and Safety Act and the Occupational Safety and Health Act; the reports are confidential, and failing to file one is a petty offense820 ILCS 305/6 (b)
• The employee gives the employer notice of the accident as soon as practicable and no later than 45 days after it (90 days after learning of an excessive radiation dose); notice may be oral or written and gives the approximate date and place820 ILCS 305/6 (c)

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 Illinois incident report requirements.