Using the MIOSHA Employee Injury/Illness Incident Report Form

To use the online form, you must have Adobe Reader or Adobe Acrobat and an established email application such as Outlook.  If you don’t have Adobe and an accessible email account you cannot use this form and must call 844-464-6742 to report the injury.

In using the form, ensure all asterisked fields are completed. Clicking the "Check Form Completeness" button at the bottom of the form begins the final steps of the process ending with an email addressed to the MIOSHA Injury & Illness Reporting line. Attached to that email is the xml file representing the data that was typed into the form. The very last step of the process is to click on the "send" button of the email to actually submit the data to MIOSHA. 

As an alternative, employers can provide the information through the MIOSHA Severe Injury Report Line at 844-464-6742 Monday through Friday 8:00 a.m. to 5:00 p.m. or leave a message after hours. 

If you have any questions, please contact MIOSHA Information Services Section staff at 517-284-7788.

Related Documents
Injury & Illness Reporting Form (This form works best with Internet Explorer) PDF icon
MIOSHA Injury & Illness Reporting Information DOC icon