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How to Report an Injury or Illness

You should always report a workplace injury as soon as possible. Not reporting may leave you holding the bill for medical treatment plus loss of wages. You shouldn’t pay for an injury your employer is responsible for, nor should you use precious vacation time to heal from that injury.  If your employer does not have an injury report form, CSEA has created a form you can use to document the important information needed to move forward with your claim. After completion you can email, print, or save it.

Your employer is required to implement a system to report workplace injuries and illnesses and must train all employees how to report them. Your employer should have a reporting form or phone number to call if you are hurt or made ill at work. Your supervisor or human resource office should be able to help you through the process.  If not, contact your highly trained OSH Specialist for guidance.

Don’t forget to save and print your form!

Please note, filling out this form on-line does not constitute reporting the injury to your employer.  You must email or print and deliver this form to any party you wish to receive it.

Always keep a copy for your records.


Any employee can report a safety concern to OSHA or PESH.