Washington incident report template

Washington rules for this report

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

• The employer reports to DOSH within eight hours of a work-related incident that results in a fatality or an inpatient hospitalization of any employee, and within 24 hours of one that results in an amputation or loss of an eye without inpatient hospitalization (counted from when the employer learns of it, or learns it was work-related), by telephone to 1-800-4BE-SAFE (1-800-423-7233), in person to the nearest DOSH office, by telephone to 1-800-321-OSHA, or to DOSH by any other meansWAC 296-27-031 (1) to (6)
• The report to DOSH gives the establishment name; the location, time and date of the incident; the type of reportable event; the number and names of the employees affected; a contact person and phone number; and a brief description of the incidentWAC 296-27-031 (7)
• A fatality is reported only if it occurs within 30 days of the incident; incidents on a commercial or public transportation system are not reported (but are recorded); a heart attack at work resulting in death or inpatient hospitalization is reported; hospitalization only for observation or diagnostic testing is notWAC 296-27-031 (8) to (11)
• Equipment involved in a work-related accident that results in a death, inpatient hospitalization, amputation or loss of an eye is not moved until a Labor and Industries representative investigates and releases it, unless moving it is necessary to remove victims or prevent further incidents and injuriesWAC 296-800-32010
• For such an incident, the employer assigns the immediate supervisor, employees who witnessed it and others the investigator needs to assist Labor and Industries staff who arrive to investigateWAC 296-800-32015
• For all serious injuries, a preliminary investigation evaluates the facts relating to the cause of the incident, conducted by a person the employer designates, the injured employee's immediate supervisor, witnesses, an employee representative (such as a shop steward or another person the employees choose) and anyone else with the experience and skills; it notes where and when it happened, who was present, what the employee was doing and what happenedWAC 296-800-32020
• The employer documents the preliminary investigation findings for use at any formal investigationWAC 296-800-32025

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 12, 2026. Read the full Washington incident report requirements.