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Montana incident report template

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Your Montana incident report has 5 rules to meet. ReportDraft puts every one on your checklist and checks your draft before you sign.

  • A full report of every accident or injury to the insurer
  • The first report to the insurer within 6 days of notice
  • The time, place and nature of the injury, as the employee's notice needs them

An incident report template set up for Montana, with fields for the notice of the accident received (date, from whom) and first report of injury sent to the insurer (date). In Word and PDF.

See a free preview filled from sample notes

REPORTDRAFT.COM
Montana Incident report Template
Company or organization
Site address or location
Date of the incident
Type of incident
Completed by
Notice of the accident received (date, from whom)
First report of injury sent to the insurer (date)
Download in Word or PDFIncluded with ReportDraft Safety and its free trial.

Montana rules for this report

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

  • Every insured employer files with its insurer, under the Department's rules, a full and complete report of every accident, injury or occupational disease to an employee arising out of or in the course of employmentMCA 39-71-307 (1)
  • The employer submits the first report of injury or occupational disease form to its insurer within six days of notice of the accident, injury or disease; an employer without workers' compensation coverage submits it to the Department, and an employee may also submit one to the DepartmentARM 24.29.801 (amended eff. 2025-07-01)
  • An employer or insurer that refuses or neglects to submit the reports needed to file and review a claim is assessed a penalty of 200 to 500 dollars for each offense, which it may contest in a Department hearingMCA 39-71-307 (3)
  • Every insurer files reports of every injury or occupational disease with the Department under its rulesMCA 39-71-307 (2)
  • An injury claim is compensable only if, within 30 days of the accident, the employer or insurer is told the time and place of the accident and the nature of the injury; actual knowledge by the employer, its managing agent or the superintendent in charge counts as notice (occupational diseases excepted)MCA 39-71-603 (1)

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 Montana incident report requirements.