Incident Complaint Report

Form Template

The Federal OSHA reporting requirements are designed to take corrective action of hazardous occupational situations to create and maintain a safe workplace.

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This app replaces the cumbersome paper OSHA form with an electronic record.

Sometimes, an employer or employee who works in an industry becomes aware of occupational safety issues that must be addressed. That's why any employee can file an Incident Complaint Form when they observe unsafe working conditions that could trigger workplace injuries or violate health standards. OSHA regulations require all employers with more than ten employees to maintain records regarding occupational injuries and illnesses. Filing a complaint will alert the OSHA administration and the facility’s insurance company to a potential claim and the need for an investigation.

Employees who file a complaint of a willful violation of a standard are sometimes called a “whistleblower.” If they report work-related injuries, they may suffer retaliation by their company, even wrongful termination. When an OSHA inspector can confirm a violation and enforce new safety protocol, they can reduce future injury. This app generates a PDF that can be stored in your GoCanvas account. It allows you to follow-up on the status of corrective actions.

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