Workers’ Compensation Incident Checklist and Report
Checklist
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)