Labor and Economic Opportunity
In using this form, ensure all asterisked fields are completed. Clicking the "Submit" button at the end of the form will submit your report to MIOSHA. You will receive a response email from MIOSHA that contains the data that was typed into the form as well as your report number.
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.