Vermont incident report template

Vermont 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, sustained by its employees at work, and reports any injury causing an absence of one day or more, or needing medical attendance, to the Commissioner of Labor in writing on the Commissioner's forms within 72 hours of the injury, Sundays and legal holidays excluded21 V.S.A. 701 (a)
• When the disability ends the employer files a final report, and while it continues the employer files a supplemental report at the end of each 60-day period saying the employee is still disabled21 V.S.A. 701 (b), (c)
• The report states the name and nature of the employer's business, where the accident happened, the injured employee's name, age, sex, wages and occupation, the date and hour of the accident, the injury's nature and cause, and anything else the Commissioner requires; an employer who refuses or neglects to report may be assessed up to 100 dollars per violation21 V.S.A. 702
• The employee gives the employer notice of the injury as soon as practicable, in writing, with the employee's name and address and the time, place, nature and cause of the injury in ordinary language, signed by the employee or someone on the employee's behalf; a claim follows within six months unless compensation is being paid voluntarily21 V.S.A. 656 (a), (c) · 21 V.S.A. 658
• Employers post a notice telling employees where they may review the employer's record of workplace safety, including injury and illness data; the record is available to employees at the workplace and to the Commissioner, but is not otherwise public21 V.S.A. 691a (b)
• VOSHA applies the federal reporting rule: a work-related death is reported to OSHA or VOSHA within 8 hours, and an in-patient hospitalization, amputation or loss of an eye within 24 hours, by phone or in person to OSHA, or through VOSHA's online reporting formVermont Department of Labor: Mandatory Reporting of Injuries/Illnesses to VOSHA

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 Vermont incident report requirements.