Kentucky incident report template

Kentucky rules for this report

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

• The employer reports any work-related injury or disease, or alleged one, to its workers' compensation carrier or the party responsible for paying benefits within three working days of being notified of it; the carrier then reports to the Department of Workers' Claims within one weekKRS 342.038 (1), (3)
• Every employer keeps a record of all injuries, fatal or otherwise, received by its employees in the course of employment; an injury causing more than one day's absence is reported to the Department within one week of its occurrence and knowledge, in the manner the commissioner directsKRS 342.038 (1)
• The injury report gives the employer's name and the nature and location of its business; the employee's name, age, sex, wages and occupation; the date and hour of the accident; and the nature and cause of the injury, plus anything else the commissioner requires. A supplementary report follows when the disability ends, and also at 60 days if it lasts longerKRS 342.038 (2), (5)
• The employee (or someone on the employee's behalf) gives the employer notice of the accident as soon as practicable, in writing, with the employee's name and address, the time, place, nature and cause of the accident, the names of witnesses, the nature and extent of the injury and the work being done, signed by the employee or someone for them; a claim is filed with the Department within two yearsKRS 342.185 (1) · KRS 342.190
• An inaccurate notice is still valid unless the employer was actually misled to its harm, and missing or late notice does not bar a claim if the employer or its agent knew of the injury or the delay had a mistake or other reasonable causeKRS 342.200
• Kentucky's OSH Program requires employers to comply with the federal recording and reporting rules in 29 CFR Part 1904803 KAR 2:181, Section 2 (effective 2026-02-03)

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 Kentucky incident report requirements.