Newfoundland and Labrador incident report template

Newfoundland and Labrador rules for this report

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

• Where an accident at a workplace results in serious injury or death, or had or still has the reasonable potential to cause serious injury or death, the employer or principal contractor immediately notifies the assistant deputy minister and immediately tells the committee, worker health and safety representative or workplace health and safety designateOccupational Health and Safety Act, RSNL 1990, c. O-3, s. 54 (1), (2)
• For immediate notice, a serious injury is a fracture of the skull, spine, pelvis, femur, humerus, fibula, tibia, radius or ulna; an amputation of a major part of a hand or foot; loss of sight of an eye; a serious internal haemorrhage; a burn that requires medical attention; an injury caused by explosives; asphyxiation or gas poisoning causing partial or total loss of physical control; or another injury likely to endanger life or cause permanent injury, but not an injury treated by first aid or medical treatment after which the worker returns immediately or at the next scheduled shiftOccupational Health and Safety Act, s. 54 (3)
• Unless the assistant deputy minister or an officer directs otherwise, no one disturbs the scene of an accident that results in serious injury or death, except to attend to the injured or dead, prevent further injury, and protect endangered propertyOccupational Health and Safety Act, s. 55
• Within 3 days after an accident that seriously injures a worker, the employer gives the minister written notice of the nature of the accident, its time and place, the injured worker's name and address, and the treating physician's name and address (a copy of the report of injury form is acceptable); a fatality is reported immediately by telephone or other available means and followed up in writing within 5 daysOccupational Health and Safety Regulations, 2012, NLR 5/12, s. 10 (2) to (4)
• For the written notice, a serious injury includes one that puts life in jeopardy, causes unconsciousness or substantial loss of blood, fractures a leg or arm (not a finger or toe), amputates a leg, arm, hand, foot, finger or toe, burns a major portion of the body, or causes loss of sight in an eyeOccupational Health and Safety Regulations, 2012, s. 10 (1)
• Where the minister finds it impractical to investigate an accident, the employer's investigation report, prepared in consultation with the occupational health and safety committee, worker representative or designate, is forwarded to the ministerOccupational Health and Safety Regulations, 2012, s. 10 (5)

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 Newfoundland and Labrador incident report requirements.