TEMPLATE

Rhode Island incident report template

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Your Rhode Island incident report has 6 rules to meet. ReportDraft puts every one on your checklist and checks your draft before you sign.

  • A death, medical treatment, or 3+ days without full wages: report to the Director
  • The report: 48 hours for a death, otherwise 10 days
  • The supplementary report when the incapacity ends

An incident report template set up for Rhode Island, with fields for the reportable because of (death, medical treatment, or 3 or more days unable to earn full wages), report to the Director of Labor and Training (date) and supplementary report when the incapacity ends (date). In Word and PDF.

See a free preview filled from sample notes

REPORTDRAFT.COM
Rhode Island Incident report Template
Company or organization
Site address or location
Date of the incident
Type of incident
Completed by
Reportable because of (death, medical treatment, or 3 or more days unable to earn full wages)
Report to the Director of Labor and Training (date)
Supplementary report when the incapacity ends (date)
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Rhode Island rules for this report

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

  • The employer reports to the Director of Labor and Training every work injury that proves fatal, keeps the employee from earning full wages for at least three days, or requires medical treatment whatever the period of incapacityR.I. Gen. Laws 28-32-1 (a)
  • The report is due within 48 hours for an injury that is immediately fatal, within 48 hours after a later death comes to the employer's knowledge, and within ten days after the injury otherwise (for an occupational disease, ten days after the employer learns of the incapacity)R.I. Gen. Laws 28-32-1 (b)
  • When the period of incapacity ends, whatever its length, the employer files a supplementary report, and the report forms include an explanation of the cause of the injury as far as possibleR.I. Gen. Laws 28-32-1 (c)
  • The Director may assess a penalty of 250 dollars for each refusal or neglect to make a required report, enforced by the Workers' Compensation CourtR.I. Gen. Laws 28-32-2
  • Reports are not open to the public, are used only for state investigation and statistics, and are not admitted in evidence in any trial or proceeding except a prosecution under the Workers' Compensation ActR.I. Gen. Laws 28-32-5 · R.I. Gen. Laws 28-32-4
  • The employee gives the employer notice within thirty days after the injury happens or shows itself, stating in ordinary language its nature, time, place and cause and the injured person's name and address, signed by the injured person or someone on their behalfR.I. Gen. Laws 28-33-30 · R.I. Gen. Laws 28-33-31

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 Rhode Island incident report requirements.