Workers’ Compensation Incident Checklist and Report

Health & Wellness
Safety & OSHA

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  • Incident Report completed by employee (due same day)
  • All necessary parties informed
  • Drug screen performed (if reasonable basis to suspect that drug or alcohol use could have contributed to the injury/accident)
  • WC Claim filed with ABC Insurance Company (within 24 hours)
  • OSHA Form 300 and 301 completed (if recordable)
  • Accident Investigation completed by supervisor (due within 48 hours)
  • Supervisor notified of upcoming appointments (PT, follow-up, referrals)
  • Employee reimbursed for mileage (if necessary)
Worker's comp form