TEMPLATE

South Dakota incident report template

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

  • A signed record of every injury within 7 days, copy to the employee, kept 4 years
  • Beyond minor first aid or 7+ days off: the report to the insurer within 7 days
  • The employee's written notice within 3 business days: when, where and how

An incident report template set up for South Dakota, with fields for the employee's written notice received (date), signed injury record copy given to the employee (date) and report filed with the insurer (or the Department if self-insured) (date). In Word and PDF.

See a free preview filled from sample notes

REPORTDRAFT.COM
South Dakota Incident report Template
Company or organization
Site address or location
Date of the incident
Type of incident
Completed by
Employee's written notice received (date)
Signed injury record copy given to the employee (date)
Report filed with the insurer (or the Department if self-insured) (date)
Download in Word or PDFIncluded with ReportDraft Safety and its free trial.

South Dakota 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 keeps a record of all injuries, fatal or otherwise, to its employees in the course of employment, completed within seven calendar days (not counting Sundays and legal holidays) after learning of the injury, on a Department-approved form, signed by the employer with a copy given to the injured employee, and kept at least four years; failing to complete or keep it is a Class 2 misdemeanorSDCL 62-6-1
  • For an injury that needs medical treatment beyond minor first aid, or that incapacitates the employee for seven or more calendar days, the employer files a written report on a Department-approved form with its insurer (or with the Department if self-insured) within seven calendar days, not counting Sundays and legal holidays, after learning of it, unless it has good cause; failing to file is a Class 2 misdemeanor with a 100 dollar administrative fineSDCL 62-6-2
  • The insurer files a copy of the report with the Department within ten days of receiving it, and the insurer (or self-insured employer) tells the employee and the Department in writing within twenty days if it denies coverage, with the reasons and the right to a hearingSDCL 62-6-3
  • An employee claiming compensation notifies the employer immediately or as soon as practical, and gives written notice no later than three business days after the injury, saying when, where and how it occurred; late notice bars the claim unless the employer actually knew or the employee had good causeSDCL 62-7-10
  • Information obtained under the workers' compensation title is used only for the Department's and insurer's purposes, apart from limited releases to the injured employee, their attorney and certain public agenciesSDCL 62-6-5

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 South Dakota incident report requirements.