New Hampshire incident report template

New Hampshire 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 records work-connected injuries and diseases in sufficient detail and keeps the record for 5 years from the date of injury; a completed Notice of Accidental Injury (form 8aWCA) together with the Employer's First Report of Injury (form 8WC) proves complianceLab 504.02 (a) · RSA 281-A:53, I
• For any injury or disease that needs medical attention, the employer has the injured employee complete the Notice of Accidental Injury or Occupational Disease (form 8aWCA) as soon as possible, and acknowledges receipt by signing it and giving the employee a copyLab 504.02 (b)
• The Employer's First Report of Injury (form 8WC) is filed with the Department of Labor as soon as possible and no later than 5 days after the employer learns of the injury, with the report sent to the insurance carrier at the same time; filing it does not give up the right to contest the claimRSA 281-A:53, I · Lab 504.02 (c) to (e)
• For an injury that needed only first aid, an employer that does not dispute it may skip sending the first report to the carrier if it pays the bill within 30 days; if the injury then needs more treatment or causes lost time, the employer notifies the carrierLab 504.02 (g), (h)
• If the injury causes disability beyond 3 days and the first report did not say so, the employer files an Employer's Supplemental Report of Injury (form 13WCA) with the Department, with a copy to the carrier's nearest claims office, no later than 7 days after the first day of disability; another goes in when the employee returns to work after compensable disabilityLab 504.02 (j) · RSA 281-A:53, I
• Failing to file a first report, or filing it late, brings a civil penalty of up to 2,500 dollars; an employer may not discourage employees from reporting injuries or penalize them for it, on pain of up to 2,500 dollars per violationRSA 281-A:53, I · Lab 504.02 (i)
• First Reports of Injury are filed electronically by the insurance carrier or self-insured employer in the manner the Department prescribes, unless the commissioner grants a hardship varianceRSA 281-A:53, III

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 New Hampshire incident report requirements.