Texas incident report template

Texas 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 and fatal injuries to employees as reported or otherwise made known, including the employee's name, address, date of birth, sex, wage, length of service and occupation, the reported cause and nature of the injury, the body part affected and any equipment involved, the date, time and location, the immediate supervisor, any witnesses, the treating health care provider if known, and any voluntary benefits paid28 TAC 120.1 (a) · Texas Labor Code 409.006
• The injury record is kept until five years from the last day of the year the injury occurred, or the period OSHA requires, whichever is longer, and is open to the Division's inspection on at least five working days' notice; failing to keep or show it can bring an administrative penalty of up to 500 dollars28 TAC 120.1 (b) to (d)
• The employer reports to its insurance carrier each death, each occupational disease it has notice or knowledge of, and each injury causing more than one day's absence from work, no later than the eighth day after the absence passes one day or after it learns of the disease or death; the report carries the injury record's informationTexas Labor Code 409.005 (a), (b) · 28 TAC 120.2 (a) to (c) (amended eff. 2025-03-26)
• When it reports to the carrier, the employer gives the injured employee a written copy of the report and a written copy of the Notice of Injured Employee Rights and Responsibilities, in English and Spanish or English and another language common to the employee, by personal delivery, mail, electronic submission or fax28 TAC 120.2 (d) · Texas Labor Code 409.005 (c), (g)
• The employer keeps a record of the date the copy of the report and the Notice of Rights and Responsibilities were given to the employee, and the date the report was filed with the carrier; if the carrier never received it, the employer must prove it was filed on time28 TAC 120.2 (f), (g)
• An employer without workers' compensation coverage files a report with the Division of each on-the-job injury that keeps an employee off work more than one day and each occupational disease it knows ofTexas Labor Code 411.032
• The employee, or someone acting for them, notifies the employer (or a supervisor or manager) of an injury within 30 days after it occurs, or for an occupational disease within 30 days after learning it may be work-relatedTexas Labor Code 409.001
• The injury report is not an admission or evidence against the employer or carrier where the facts are contradicted, and the injury record is not an admission that the injury occurred or that its facts are true; the carrier files the report with the Division within seven days of receiving itTexas Labor Code 409.005 (d), (f), 409.006 (d)
• On written request of the employee, a doctor, the carrier or the Division, the employer says whether modified duty or a return-to-work program is available, and if so names its contact personTexas Labor Code 409.005 (j)

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 Texas incident report requirements.