Tennessee incident report template

Tennessee rules for this report

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

• An employer must accept any notice of a workers' compensation claim from any employee or employee's representative who alleges an injuryTenn. Comp. R. & Regs. 0800-02-01-.05 (1)
• Employers report all known or reported accidents or injuries to their adjusting entity within one business day of knowledge of the injury, and may not pay benefits in a way that shifts responsibility away from the adjusting entity or conceals the injury or the paymentsTenn. Comp. R. & Regs. 0800-02-01-.05 (2), (3)
• Once the employer has notice of a work injury and the employee expresses a need for medical care, the employer gives the employee a panel of physicians as T.C.A. 50-6-204 prescribes, as soon as practicable and no later than three business days; an inadequate or late panel can bring a civil penalty whether or not the claim is compensable, and an in-house or onsite provider visit does not replace the panelTenn. Comp. R. & Regs. 0800-02-01-.06 (1), (2), (4)
• For a workplace injury needing emergency care, the employer immediately provides proper emergency assistance (EMTs, an ambulance) and follows the panel rule once the employee is stableTenn. Comp. R. & Regs. 0800-02-01-.06 (3)
• Each employer keeps the Tennessee Workers' Compensation Posting Notice continuously posted in one or more conspicuous places at each worksite, telling employees about the Bureau's services, the duties of employer and employee, and whom to contactTenn. Comp. R. & Regs. 0800-02-01-.12 (2)
• The adjusting entity files Tennessee's First Report of Work Injury with the Bureau by EDI as soon as possible whenever the injury results in a need for medical treatment, restricted work, inability to work or death, within the time frames of T.C.A. 50-3-702Tenn. Comp. R. & Regs. 0800-02-14-.04 (5) (Nov. 2025)
• Within two business days of the employer's notice of any injury, the adjusting entity mails the employee a Notice of a Reported Injury and the Beginner's Guide to Tennessee Workers' Compensation, and makes its first decision on compensability within 15 calendar days of the noticeTenn. Comp. R. & Regs. 0800-02-14-.04 (6), (8)

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 Tennessee incident report requirements.