New Mexico incident report template

New Mexico 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 under the Act, or its workers' compensation carrier, makes a written report to the director of every injury or occupational disease in the course of employment that results in more than seven days of lost time, within ten days after the injury or after the employer is notified of the disability, and the employer sends the worker a copyNMSA 1978, 52-1-58 (A)
• First report of injury data reaches the WCA within 10 days of notification for every injury or occupational disease resulting in more than seven cumulative days of lost time or death, on time even if the claim is disputed; the claim administrator gives the worker and the employer a copy at submission, and an uninsured employer gives the worker a copy11.4.2.8 (F) (1), (7), (8) NMAC (eff. 2025-11-07)
• The worker notes, briefly describes and signs the director-approved Notice of Accident form; the employer, superintendent, foreman or agent in charge of the work also signs it, which only acknowledges receipt and concedes no rights or defenses; the form is in duplicate so worker and employer each keep a copyNMSA 1978, 52-1-29 (C)
• The employer keeps the director-approved accident notice poster up in conspicuous places where employee notices are posted, telling workers to give written notice of an accident within fifteen days, with an adequate supply of Notice of Accident forms attached; without the poster, the worker's time to give notice runs to the sixty-day maximumNMSA 1978, 52-1-29 (B) · 11.4.2.10 NMAC (eff. 2025-11-07)
• The worker gives the employer written notice of the accident within fifteen days after knowing or having reason to know of it, or, if the injury or another cause beyond their control prevents that, as soon as reasonably possible and no later than sixty days; no written notice is needed when the employer or the supervisor in charge of the work knew of the accidentNMSA 1978, 52-1-29 (A)
• No compensation claim is barred before the report is filed or within thirty days after itNMSA 1978, 52-1-59
• The director fines anyone who fails to file a required report or breaks the Act or its rules 25 to 1,000 dollars for each occurrence, unless the Act sets another penaltyNMSA 1978, 52-1-61

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 Mexico incident report requirements.