Ontario incident report template

Set up for Ontario

• The written report or notice gives the employer's name, address and type of business; the worker's name; the nature of the bodily injury or occupational illness; the names and addresses or other contact information of witnesses; and the steps taken to prevent a recurrence or further illness; a death or critical injury report adds the constructor's name and address if at a project, the worker's address, the nature and circumstances of the occurrence including any machinery, equipment or procedure involved, its time, date and place, and the name and address of the physician, nurse practitioner or medical facility attending the workerO. Reg. 420/21, s. 3

Also required in Ontario

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

• When a person is killed or critically injured from any cause at a workplace, the constructor (if any) and the employer notify an inspector, and the committee, health and safety representative and trade union (if any), immediately by telephone or other direct means; the employer sends a written report of the circumstances to a Director and to the committee, representative and union within 48 hoursOccupational Health and Safety Act, R.S.O. 1990, c. O.1, s. 51 (1) · Ministry: Reporting workplace incidents and illnesses
• Critically injured means an injury of a serious nature that places life in jeopardy, produces unconsciousness, results in substantial loss of blood, involves the fracture of a leg or arm (not a finger or toe), involves the amputation of a leg, arm, hand or foot (not a finger or toe), consists of burns to a major portion of the body, or causes the loss of sight in an eyeO. Reg. 420/21, s. 1 (1)
• After a death or critical injury, no one may interfere with, disturb, destroy, alter or carry away any wreckage, article or thing at the scene until an inspector gives permission, except to save life or relieve suffering, maintain an essential public utility or public transportation, or prevent unnecessary damage to equipment or propertyOHSA, s. 51 (2)
• If a person is disabled from performing their usual work or requires medical attention because of an accident, explosion, fire or incident of workplace violence, and no one dies or is critically injured, the employer gives written notice within four days to the committee, health and safety representative and trade union (if any), and to a Director if an inspector requires itOHSA, s. 52 (1)
• When a worker or former worker advises the employer of an occupational illness, or of a Workplace Safety and Insurance Board claim for one, the employer gives written notice within four days to a Director, the committee or health and safety representative, and the trade union (if any), including the cause or suspected cause of the illnessOHSA, s. 52 (2), (3) · O. Reg. 420/21, s. 3 (2) 6
• After an accident, unexpected explosion, fire, flood, equipment failure, cave-in or other prescribed incident at a project site or mine, the constructor (project) or employer (mine) gives written notice within two days to the committee, representative and trade union, and to a Director unless a section 51 report or 52 notice already went to one; on construction projects prescribed incidents include a fall of three metres or more, a fall stopped by a fall arrest system, a worker becoming unconscious, and accidental contact with energized electrical equipmentOHSA, s. 53 · O. Reg. 420/21, s. 4
• Medical attention means treatment from a legally qualified medical practitioner or a registered nurse holding an extended certificate of registration (nurse practitioner)O. Reg. 420/21, s. 1 (1)
• The section 51 and 52 reporting contents do not apply to a death or injury from a motor vehicle collision on a highway (including Highway 407) unless the worker was working at a project or was not travelling in the vehicleO. Reg. 420/21, s. 2 (2)

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 Ontario incident report requirements.