Utah incident report template

Utah rules for this report

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

• Within 8 hours, the employer notifies UOSH (the rule lists 801-530-6901) of any work-related fatality, any disabling, serious or significant injury, and any occupational disease incident. A disabling, serious or significant injury is one that leads to hospital admission, or to a permanent or temporary impairment substantially reducing the function of a body part that needs treatment by a physician or other licensed health care professional, such as an amputation, fracture, deep laceration, severe or electrical burn, sight impairment, loss of consciousness or concussionUtah Admin. Code R614-1-5 (B) (1); R614-1-3 (definition)
• Tools, equipment, materials or other evidence that might bear on the cause of such an accident are not removed or destroyed until UOSH or one of its compliance officers authorizes itUtah Admin. Code R614-1-5 (B) (2)
• Each employer investigates, or has investigated, all work-related injuries and occupational diseases, and any sudden or unusual occurrence or change of conditions that exposes employees to unsafe or unhealthful conditionsUtah Admin. Code R614-1-5 (B) (3)
• Except for injuries treated only with first aid, the employer reports each work injury within 7 days after first notice of it: to its workers' compensation carrier, to its claims administrator if self-insured, or directly to the Industrial Accidents Division if uninsured. The employer has notice at the earliest of seeing the injury, hearing of it verbally or in writing from any source, or getting other information that warrants inquiryUtah Admin. Code R612-200-1 (A)
• The employer and its carrier file a report of every work-related fatality and every work injury resulting in medical treatment, loss of consciousness, loss of work, restricted work or transfer to another job (a minor cut or scratch needing only first aid is excepted), and the carrier or self-insured employer files the First Report of Injury with the Division within 14 daysUtah Code 34A-2-407 (5) · Utah Admin. Code R612-200-1 (B) (2)
• The employer and carrier that file the report give the employee a copy of the report submitted to the Division and the Division's statement of the employee's rights and responsibilitiesUtah Code 34A-2-407 (6)
• The employer keeps a record, in the form the Commission sets, of all work-related fatalities and injuries resulting in medical treatment, loss of consciousness, loss of work, restricted work or transfer; refusing or neglecting to report or keep records can bring a civil assessment of up to 500 dollars, unless a late report had good causeUtah Code 34A-2-407 (7), (8)
• An injured employee notifies the employer promptly (next of kin or an attorney may do it if the employee cannot); a claim is barred if neither the employer nor the Division is notified within 180 days of the injury. An employer's report filed with the Division or its carrier counts as noticeUtah Code 34A-2-407 (2) to (4)

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 13, 2026. Read the full Utah incident report requirements.