Maine incident report template
ReportDraft Safety from $12 a month. 14-day free trial with your first report and up to 5 template downloads. Card required, nothing charged today, cancel anytime. Need just one? One incident report for $19, no subscription.
Your Maine incident report has 4 rules to meet. ReportDraft puts every one on your checklist and checks your draft before you sign.
- A lost day's work: report to the Board within 7 days
- Every OSHA 301 item, completed within 7 calendar days for a recordable case
An incident report template set up for Maine, with fields for the health care provider services required (who and when), did the employee lose a day's work? (dates) and first report of injury completed, copy to the employee, and filed with the Board (dates). In Word and PDF.
Maine rules for this report
These rules are about how and when you report, not the template's fields. Check them before you deliver.
- For any injury that has required the services of a health care provider, the employer completes a first report of injury form within 7 days after receiving notice or knowledge of the injury, gives the injured employee a copy and keeps a copy for its records39-A M.R.S. s. 303 (as amended by PL 2023, c. 205)
- When an injury causes the employee to lose a day's work, the employer reports it to the Workers' Compensation Board within 7 days after receiving notice or knowledge of it; a first report kept on file is submitted to the Board if the injury later causes a lost day, or when Board rules require electronic filing39-A M.R.S. s. 303
- Within 30 days after notice of a compensation claim, the employer reports the employee's average weekly wages to the Board and mails a copy of the wage information to the employee, and later reports when the employee returns to work and the wages then39-A M.R.S. s. 303
- After an incapacity beyond the 14-day waiting period, time an employee later spends at related medical appointments need not be reported as lost time if the employee lost no wages for it39-A M.R.S. s. 303
- For injuries on or after January 1, 2020, the employee (or someone for them) gives notice within 60 days after the injury, stating the time, place, cause and nature of the injury and the employee's name and address; notice may go to the employer, a corporate official, a designated employee, the supervisor in charge, or on-site medical staff39-A M.R.S. s. 301
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 Maine incident report requirements.