Sample Employee Incident Report Letter

Sample Employee Incident Report Letter

Employee incidents are a common and routine part of any job environment. They can be medical, relational, or safety incidents, but any incident will need to be recorded by Human Resources in an Employee Incident Report Letter. A sample Employee Incident Report Letter can be downloaded below.

To create a Sample Incident Report Letter, include the following information:

  1. Today's Date.
  2. The employee's and supervisor's names and job titles.
  3. Opening Salutation to the Supervisor or HR representative.
  4. Explain the incident that took place as clearly and accurately as possible.
    • If there were any witnesses to the incident, include their names;
    • Explain any injuries (emotional or physical) that occurred as a result of the incident and any treatment you have received since the incident occurred.
  5. If your company will provide care related to the incident, request what type of care you are requesting.
    • If you have a note from a doctor detailing the recommended care, attach a copy of it to the letter.
  6. Mention any time off that you may need to recover from the incident and request information about workers' compensation you may be entitled to.
  7. Close by thanking your supervisor or the HR representative.
  8. Your name and signature.

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Download Sample Employee Incident Report Letter

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