Serious Event Reporting Online Form

OMB Control Number: 1218-0176
Expiration Date: April 30, 2025

Select State of the event to determine reporting requirements.

The fields indicated with an asterisk (*) are required to complete your submission.

State Exemption Message: Employers under Alaska jurisdiction cannot use this application to report work related fatalities or severe injury or illness. Occupational accidents that result in the death or overnight hospitalization of one or more employees must be reported to AKOSH within 8 hours. Immediately report accidents to:

  • 1-800-770-4940 or (907) 269-4940 (8 am to 5 pm M-F; AK time)
  • 1-800-321-6742 (After 5 pm or on weekends and holiday)

State Exemption Message: The revised fatality and severe injury and illness reporting requirements will not be effective in Arizona State Plan until January 15, 2016.

Call the Arizona Division of Occupational Safety and Health (ADOSH) at (602) 542-5795 or toll free at (855) 268-5251 to file the report.

See our webpage at: https://www.azica.gov/adosh-how-report-workplace-fatality for further information.

State Exemption Message: Employers under California State Plan (Cal/OSHA) jurisdiction cannot use this application to report work related fatalities or serious injuries or illnesses.

Call the Cal/OSHA District Office that covers your work location to file the report. For the phone number to call, please refer to
http://www.dir.ca.gov/dosh/report-accident-or-injury.html.

State Exemption Message: Employers under Hawaii's State Plan (HIOSH) jurisdiction cannot use this application. Employers must report to HIOSH, via the telephone, all work-related fatalities, inpatient hospitalizations of an employee, amputations, incidents resulting in the loss of an eye and incidents that results in property damage greater than $25,000.

To report an incident to HIOSH, call (808) 586-9102.

When reporting please provide the following information:

  • Employer name, contact person and phone number of the contact person
  • Date and time of the incident
  • Name(s) and condition of the employee(s) involved
  • Brief description of the incident

State Exemption Message: Employers under Kentucky jurisdiction cannot use this application.

Employers must orally report fatalities, hospitalizations, and amputations to the Kentucky Labor Cabinet, Department of Workplace Standards, Division of Occupational Safety and Health Compliance, at (502) 564-3070.

If the employer cannot speak directly with someone in Kentucky at (502) 564-3070, the employer must report the incident using the OSHA toll-free, central telephone number 1-800-321-OSHA (1-800-321-6742).

State Exemption Message: Employers under State of Maryland jurisdiction cannot use this application to report work related fatalities or severe injury or illness.

To report a work related fatality, please call the Maryland Occupational Safety and Health Administration (MOSH) Fatality Hotline at 1-888-257-6674.

To report an employee's work related in-patient hospitalization, amputation, or loss of an eye, please call the MOSH toll-free line at 1-800-759-6297 or 410-527-4447.

For Spanish speaking employers please call 410-527-2069.

State Exemption Message: Employers under State of Michigan jurisdiction cannot use this application to report work related fatalities or severe injury or illness.

To report a work related fatality, please call the Michigan Occupational Safety and Health Administration (MIOSHA) Fatality Hotline at 800-858-0397.

To report an employees work related in-patient hospitalization, amputation, or loss of an eye, please call the MIOSHA toll-free line at 844-464-6742 or visit the MIOSHA website and complete the forms to submit electronically.

OSHA AFTER HOURS - REGION V
Office Name: Michigan Department of Labor and Economic Opportunity - Michigan OSHA
Business Hours Phone No.: (517) 284-7778

Call Order 1
Contact Name: Michigan Fatality Hotline
Phone No.: (800) 858-0397
Email Address: MIOSHA-Referrals@michigan.gov

Call Order 2
Imminent Danger: Call each number until you reach someone

Rotating Phone: (517) 749-1210
Eric Allen: (517) 719-1902
Laura Basile: (517) 234-8452
Dan Maki: (517) 648-7421
Nikki Clark: (313) 348-1389
Al Cudney: (517) 256-7024
Jeremy Hidalgo: (517) 242-7755
Brian Paul: (517) 242-7322
Rick Pfander: (517) 712-2152
Erica Funnell: (517) 231-6579
Adrian Rocskay: (517) 333-5963
Lawrence Hidalgo: (517) 243-1795
Barton Pickleman: (517) 243-3363

Email Address: MIOSHA-Referrals@michigan.gov

State Exemption Message: The revised fatality and severe injury and illness reporting requirements became effective in Minnesota on October 1, 2015.

If you are reporting the death of an employee or the inpatient hospitalization, amputation, or loss of an eye of an employee, please contact Minnesota Occupational Safety and Health Division at (651) 284-5050 or 1-877-470-6742 directly.

State Exemption Message: Employers under Nevada OSHA jurisdiction cannot use this application. Employers must report to NVOSHA all workplace accidents involving a fatality of one or more employees, or involving hospitalization of three or more employees, within eight (8) hours after learning of the accident.

To report an incident to NVOSHA, call (702) 486-9020 (Southern Nevada) or (775) 688-3700 (Northern Nevada).

State Exemption Message: Employers under New Mexico jurisdiction cannot use this application to report work related fatalities or severe injury or illness.

Call the Fatality Catastrophe hotline at 505-476-8700 or 877-610-4742 (toll free) to file the report.

State Exemption Message: Employers under the jurisdiction of the North Carolina Department of Labor's (NCDOL) Occupational Safety and Health (OSH) Division cannot use this application to report: work related fatalities, hospitalizations, amputations and/or loss of an eye.

To report a work related fatality, call the OSH Division at 1-800-NC-LABOR (1-800-625-2267) or 919-779-8560.

To report an employee's work related in-patient hospitalization, amputation, or loss of an eye, please use our online reporting form to submit electronically or call the OSH Division.

For a work related fatality or an incident resulting in the hospitalization of two or more employees after working hours, weekends or holidays, call the State Capitol Police at 919-733-3333.

For more information on the North Carolina Department of Labor, please visit the website NCDOL.

State Exemption Message: Although the revised requirements will not take effect until later in the year, Oregon employers are already required to report all workplace events resulting in death (including all heart attacks at work) within 8 hours and all those resulting in overnight hospital admissions for treatment within 24 hours.

Call the Fatality Catastrophe hotline at 800- 922-2689 to file the report.

State Exemption Message: Employers under State of South Carolina jurisdiction cannot use this application to report work-related fatalities or severe injury or illness.

  • To report and electronically submit information regarding an employee's work-related in-patient hospitalization, amputation, or loss of an eye, please visit: https://osha.llr.sc.gov/reportinjury.aspx
  • To report a work-related fatality, please call the South Carolina OSHA office at 803-896-7672.
  • For more information on South Carolina OSHA, please visit https://osha.llr.sc.gov/

State Exemption Message: The revised fatality and severe injury and illness reporting requirements took effect in Tennessee on February 24, 2015.

To report a fatality, hospitalization, amputation, or loss of an eye visit https://www.tn.gov/workforce/employees/safety-health/tosha-redirect/fatality--hospitalization-amputation-reporting.html or call the Tennessee OSHA Fatality/Catastrophe hotline at 800-249-8510.

State Exemption Message: Employers under UOSH's jurisdiction cannot use this application to report work related fatalities or severe injury or illness.

Utah employers are required to notify UOSH at (801) 530-6901 within 8 hours of occurrence of all work-related fatalities, of any disabling, serious or significant injury or illness to workers. Employers can call in their reports 24 hours a day, 7 days a week.

State Exemption Message: Employers under Vermont State Plan jurisdiction cannot use this application to report work related fatalities or severe injury or illness.

For more information and to file a report of serious injury/illness, fatality or catastrophe, please visit the following link:

Fatalities and catastrophes can also be reported via the OSHA Fatality/Catastrophe hotline at (802) 828-2765.

State Exemption Message: Employers under Washington State jurisdiction cannot use this application. If one or more work-related deaths, probable deaths or in-patient hospitalizations occur, employers in Washington must notify L&I DOSH within eight (8) hours with the following information or 24 hours for non-hospitalization loss of eye or amputation:

  • Employer contact person and phone number
  • Name, address and location of the workplace
  • Date and time of the incident
  • Number of fatalities or hospitalized employees
  • Names of the employees
  • Brief description of what happened

Where to report:

  • Any local L&I office or
  • 1-800-423-7233 (1800-4-BESAFE) or 360-902-5580, press 1 (available 24/7)

NOTE: For employers covered by Federal OSHA that are located in State Plan States, to make a report

  • Call the nearest OSHA office.
  • Call the OSHA 24-hour hotline at 1-800-321-6742 (OSHA).

Public reporting for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid Office of Management and Budget Control Number. If you have any comments regarding this estimate or any other aspect of this information collection, including suggestions for reducing this burden, please send them to OSHAPRA@dol.gov or to OSHA's Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210.



0/2000

0/2000



Contact 1

Contact 2

0/500

0/2000

0/2000

Was there a fatality?
Was the victim hospitalized?
Was there an amputation?
Was there the loss of an eye?


We are processing the submitted data. This may take several minutes. Please do not close or refresh the browser.