TEMPLATE

Iowa incident report template

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Your Iowa incident report has 4 rules to meet. ReportDraft puts every one on your checklist and checks your draft before you sign.

  • A record of every work injury causing more than one day of incapacity
  • Every OSHA 301 item, completed within 7 calendar days for a recordable case

An incident report template set up for Iowa, with fields for the report to the workers' compensation commissioner (date, by employer or carrier) and reported to Iowa OSHA (date, time, how). In Word and PDF.

See a free preview filled from sample notes

REPORTDRAFT.COM
Iowa Incident report Template
Company or organization
Site address or location
Date of the incident
Type of incident
Completed by
Report to the workers' compensation commissioner (date, by employer or carrier)
Reported to Iowa OSHA (date, time, how)
Download in Word or PDFIncluded with ReportDraft Safety and its free trial.

Iowa 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 a record of all injuries, fatal or otherwise, that an employee says happened in the course of employment and that cause incapacity for longer than one dayIowa Code 10A.313 (formerly 86.11), Iowa Code 2026
  • When a temporary disability causes incapacity for more than three days, the employer or insurance carrier that knows of it files a report with the workers' compensation commissioner within four days after that, not counting Sundays and legal holidays; for a permanent total or partial disability or a death, the report is due within four days after learning of the permanent injury or deathIowa Code 10A.313
  • The injury report to the commissioner is made without prejudice to the employer or carrier and may not be admitted in evidence or used in any trial or hearing, except on the question of noticeIowa Code 10A.313
  • No compensation is allowed unless the employer had actual knowledge of the injury, or the employee (or someone for the employee) gave the employer notice, within ninety days of the date the employee knew or should have known the injury was work-relatedIowa Code 85.23, Iowa Code 2026
  • Iowa OSHA adopts the federal recording and reporting rules (29 CFR 1904). Besides the federal methods, a required fatality or serious injury report may be made by faxing or emailing Iowa OSHA's incident report form, calling 877-242-6742, or visiting 6200 Park Avenue, Suite 100, Des Moines; a first report of injury filed with the Division of Workers' Compensation counts as a report to the Division of Labor Services, which receives itIowa Admin. Code 481-204.2, 481-204.3

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 13, 2026. Read the full Iowa incident report requirements.