Saskatchewan incident report template

Set up for Saskatchewan

• An employer or contractor notifies the ministry as soon as reasonably possible of every accident that causes or may cause a worker's death or will require a worker to be admitted to hospital as an in-patient for 72 hours or more, giving each injured or deceased worker's name and employer, the date, time and location, the circumstances, the apparent injuries, and a contact name with telephone and fax numbers, and gives each co-chairperson or the representative a copyThe Occupational Health and Safety Regulations, 2020, RRS c S-15.1 Reg 10, s. 2-2
• Every accident that causes or may cause a death or needs a 24-hour in-patient admission, and every dangerous occurrence, is investigated as soon as reasonably possible by the committee co-chairpersons or their designates, the employer and the representative, or the employer alone if there is neitherRRS c S-15.1 Reg 10, ss. 3-18 (1), 3-20 (1)

Also required in Saskatchewan

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

• Dangerous occurrences that could have caused a death or a 72-hour admission are reported to the ministry as soon as reasonably possible even when no one is hurt: structural failure or collapse of a structure, scaffold, falsework, formwork, shaft, tunnel, caisson, coffer dam, trench or excavation; crane or hoist failure or an overturned crane or mobile equipment; accidental contact with an energized electrical conductor; a burst grinding wheel; an uncontrolled spill or escape of a toxic, corrosive or explosive substance; a premature or accidental detonation; an elevated or suspended platform failure; and an atmosphere-supplying respirator failureRRS c S-15.1 Reg 10, s. 2-3
• After the investigation the employer, with the co-chairpersons or the representative, prepares a written report with a description of the accident or occurrence, any graphics, photographs or other evidence that helps find the causes, an explanation of the causes, the immediate corrective action taken, and any long-term action to prevent a similar one or the reasons for taking noneRRS c S-15.1 Reg 10, ss. 3-18 (2), 3-20 (2)
• After an accident causing a death, no one may disturb or move wreckage or anything connected with it except to save life or relieve suffering until an officer finishes investigating, unless an officer allows it after photographs or other evidence are made and the co-chairpersons or representative have inspected the siteRRS c S-15.1 Reg 10, s. 3-19
• Every lost-time injury that results in medical treatment is reported to the co-chairpersons, the representative or their designates, who get a reasonable chance to review it during working hours without loss of payRRS c S-15.1 Reg 10, s. 3-21
• Within five days of learning of an injury that keeps a worker from earning full wages or needs medical aid, the employer notifies the Workers' Compensation Board in writing of the nature, cause and circumstances, the time, the worker's name and address, the place, and the name and address of any attending physician; failing to is an offence with a fine of up to 1,000 dollars, and the board may make the employer pay the compensation and medical aidThe Workers' Compensation Act, 2013, SS 2013, c W-17.11, ss. 52, 54
• A worker notifies the employer and the board of an injury as soon as possible, before voluntarily leaving the job, with their name and address, the cause and the place, and claims within six months of the injury or deathThe Workers' Compensation Act, 2013, s. 44 (am. 2024, c 11)

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 16, 2026. Read the full Saskatchewan incident report requirements.