Minnesota incident report template

Minnesota rules for this report

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

• When an employee dies or is seriously injured at work, the employer reports it to the commissioner of labor and industry and the insurer within 48 hours; the first report to the commissioner may be by telephone or in person, followed by a report to the insurer within seven days. Reporting a fatality to MNOSHA within 8 hours, or an in-patient hospitalization, amputation or loss of an eye within 24 hours, satisfies the 48-hour reportMinn. Stat. 176.231, subd. 1 (a), (d), subd. 2 (a) (2025)
• Any other work injury that wholly or partly keeps the employee from working for more than three calendar days is reported to the insurer on the commissioner's form (the First Report of Injury) within ten days of the injuryMinn. Stat. 176.231, subd. 1 (a)
• Each report of injury includes the date of injury and goes in the commissioner's format, with one copy to the insurer and one to the employee; the employer gives the employee the "Minnesota Workers' Compensation System Employee Information Sheet" with the copy of the first report of injuryMinn. Stat. 176.231, subd. 2 (a)
• If an injury already reported later results in death, the employer reports the death to the commissioner and the insurer within 48 hours after learning of it; the insurer or self-insured employer reports the injury to the commissioner within 14 daysMinn. Stat. 176.231, subd. 1 (b), (c)
• Employers in the industries the commissioner lists keep a written workplace accident and injury reduction (AWAIR) program that describes, among other things, how workplace accidents will be investigated and corrective action implemented, and review it in writing at least once a yearMinn. Stat. 182.653, subds. 8, 9 (2025)

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 Minnesota incident report requirements.