Create an Injury / Illness Report Form using Google Forms

An Injury and Illness Report Form is a mandatory tool for documenting work-related injuries, illnesses, and incidents in the workplace. Proper reporting not only ensures employee safety but also helps organizations maintain compliance with OSHA regulations, streamline investigations, and prevent future incidents.

A detailed report provides a reliable written record of workplace injuries and illnesses, including when, where, and how incidents occurred, and who was involved. Accurate documentation also supports workers’ compensation claims, liability investigations, and regulatory compliance, helping your organization reduce risk and maintain transparency.

A comprehensive Injury and Illness Report Form should collect all essential information clearly, accurately, and in compliance with OSHA recordkeeping requirements. The form should include the following sections:

• Employee information: This section gathers key details about the injured or ill employee. It includes the employee’s full name, job title or position, department, date of hire, and contact information. Collecting accurate employee data ensures proper identification and supports OSHA Form 301 documentation.

• Incident details: This section records exactly when, where, and how the injury or illness occurred. It includes the date and time of the incident, the specific location within the workplace, and a factual description of the events leading up to it.

• Injury/Illness details: This section identifies the nature of the injury or illness and specifies the body part or parts affected, including whether the injury occurred on the left or right side of the body. Additionally, it documents any object, equipment, or substance that caused or contributed to the employee’s injury.

• Work status: This section outlines any changes to the employee’s ability to perform their job following the injury. It records whether the employee required days away from work, performed restricted duties, or needed a temporary job transfer. By documenting these details clearly, the form supports OSHA Form 300 log requirements and ensures accurate processing for workers’ compensation and return-to-work planning.

• Root cause analysis: This section provides a detailed examination of the factors that led to the injury or illness, identifies the immediate cause of the incident, as well as contributing factors, which may include behavioral, environmental, or mechanical elements. Conducting a thorough root cause analysis supports long-term safety improvements and reinforces proactive workplace risk management.

• Corrective and preventive actions: This section records the steps taken to address the hazard and prevent future incidents, both the immediate corrective actions implemented and the preventive recommendations. It also identifies the individuals responsible for carrying out each action, and specifies target or completion dates. Documenting these actions demonstrates organizational accountability, supports compliance with safety regulations, and helps maintain a safer workplace.

• Acknowledgement: This section includes a signature widget for the reportee’s signature to confirm the accuracy of the information provided. The approval workflow can be customized as needed to meet organizational requirements, allowing supervisors or safety officers to review, verify, and formally approve the report.

Regulatory Compliance: Templates are designed with OSHA requirements in mind, ensuring all legally required information is captured accurately for full compliance with OSHA Forms 300 and 301.

Upload Attachments: Include photos of the injury site, medical evaluations, treatment records, witness statements, and diagrams to provide complete and thorough documentation of the injury or illness for investigations and compliance.

Legally Binding Signatures: Collect signatures for legal compliance and accountability. The signed incident report PDFs can serve as official documentation if needed.

Customizable Approval Workflow: Route injury and illness reports to supervisors, HR staff, or safety officers for review, verification, and formal approval, streamlining case management.

Sync to Google Sheets: Sync form responses to Google Sheets, allowing you to track incidents, analyze trends, monitor lost-time cases, and generate data-driven safety insights.

Save to Google Drive: Automatically generate and store PDF copies of Injury and Illness Reports in Google Drive to meet OSHA’s recordkeeping requirements and easy access.

Recordkeeping Compliance: Injury and illness reports must be retained for at least five years, with some medical and exposure records requiring retention for 30 years or longer.

Privacy & Security: Injury and illness reports may contain protected health information (PHI) covered by HIPAA. Mark fields as PHI to secure sensitive data, limit access and ensure compliance.

Mobile-Friendly: Enable employees to submit injury and illness reports directly from their mobile devices, including the ability to attach photos, documents, or treatment notes immediately after an incident for faster and more accurate reporting.

Whether you're managing a construction site, healthcare facility, manufacturing plant, or office environment, using a standardized Injury and Illness Report Form ensures accurate documentation and supports OSHA compliance. This template simplifies the reporting process, helping employees and supervisors capture essential details about work-related injuries and illnesses as soon as they happen, when information is most reliable.

Create your customized injury and illness report form and make reporting faster, easier, and more compliant.