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Personnel & Safety File · Form HR-07
Incident Report
Factual record of a workplace event — injury, damage, near miss, hazard, or security incident. Completed by the reporting manager as soon as the scene is safe, then routed to HR-06 for review. Describes what happened; it is not a disciplinary action.
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v2026.01
🔓Unlocked
Part 1 — what happened. Everything here is what you can only know by being there, so fill it in now and submit.
Submitting downloads the report so the manager and the employee can sign it in ink straight away,
while the day is fresh — then upload the signed copy on the Incident records tab.
Part 2 — root cause, corrective action, and the outcomes that are not known yet — is filled in
there afterwards, as the answers arrive.
Employer information
Incident classification
People
Vehicles & property
Repair hazards
High-energy systems
Conditions & environment
Security & conduct
If this complaint is about a manager, check the location first.
A manager's PIN can read, print, download the attachments from, and amend
findings on any record filed at their own location. If the person this
report is about manages the shop where it happened, file it under
BCC Group instead, and name the shop in the description. Location
cannot be changed after submitting.
Both conduct and workplace violence are selected. Submitting writes
a Violent Incident Log entry under Labor Code 6401.9, kept five years. If
whether this was a threat is still an open question, select workplace
conduct alone and make that call in the review.
High or critical severity — notify administration immediately. Do not wait for this form. Call HR and the Operating Administrator now; submitting this report also sends an immediate alert. Preserve the scene and the equipment involved, and do not discard damaged parts until told to.
The event
Write what a person who was not there would need to understand the event. Avoid "careless", "should have", "at fault" — describe the actions and conditions instead.
People involved — a hazard or near miss may have none
Their own account, recorded before it is reconstructed from memory, is the most useful line on
this form and the hardest one to get back later. Write what they said even where it conflicts with what you saw;
do not correct it, and do not leave out the part that does not fit.
One block per person, each with their own account. Write what they said
in their words — not a summary, and not merged with anyone else's version.
Workplace violence — California SB 553 · Labor Code 6401.9
This goes on a separate log. California requires a violent incident log kept apart from the OSHA 300 log and
retained five years. The law also requires that the log omit personal identifying information — so the
classifications below, not names, are what get written to it. Names stay on this incident record only.
This exact text goes to the five-year log, which by law must not identify anyone. Use roles — "the advisor", "the customer" — not names. The full account with names stays in "What happened" above.
Reasonable suspicion — fitness for duty
Record what you observed, not what you concluded. California allows testing on
specific objective facts and rational inferences drawn from those facts — so "slurred speech, unsteady,
smelled of alcohol" is the record that holds up. "He was drunk" is not. You are not diagnosing anyone.
Do not let them drive. Arrange transport whatever the outcome of this form.
Two people who separately saw the same thing is the difference between a defensible decision and one person's word. Get a second supervisor if one is on site.
They must not drive themselves. If an impaired employee leaves your lot behind the wheel and hurts someone,
that exposure is the company's. Arrange transport, or call police if they insist on driving.
Test results are deliberately not recorded on this form. This record captures what you observed and what you
did — the conduct. Results are medical information and go to HR through the collection site and the review officer,
not into a record every manager at the location can read.
Vehicle — shown because a vehicle was involved
Mechanism — extra detail for the hazard selected
A damaged pack can reignite hours or days later. Keep the vehicle isolated outdoors, away from structures and other vehicles, and do not release it until the OEM or the carrier signs off. Note the quarantine start date in the description.
Conditions at the time — shown because the event happened around the work
Record what was actually being worn. "None in use" is a legitimate and useful answer — it is the finding that drives the fix.
If it reached a drain, the street, or soil, treat it as reportable until someone confirms otherwise. Note the product, the quantity, and where it went in the description — that is what the agency asks first.
Injury / illness — shown because an injury or illness was selected
The rule presumes work-relatedness: if an event or exposure at work caused, contributed to, or significantly aggravated a pre-existing condition, it is work-related. "Not work-related" is only available through one of the listed exceptions.
Your determination decides the OSHA log. It does not decide the claim — and it is not yours to decide.
Give the DWC-1 anyway, within one working day of the injury being reported. Withholding it because you believe the injury is not work-related is not an option.
The claims administrator decides compensability, not the shop. If liability is not rejected within 90 days of the claim form being filed, the injury is presumed compensable (Labor Code 5402(b)) — and that presumption can only be rebutted with evidence discovered afterward.
Treatment starts before the decision. Within one working day of the claim being filed, treatment must be authorized and continue until liability is accepted or rejected, up to $10,000 (Labor Code 5402(c)).
Recordability and compensability are separate tests. A case can be non-recordable and still compensable, or the reverse.
Everything here is first aid, and first aid alone never puts a case on the 300 log.
The line matters because OSHA's definition is closed: stitches, a prescription, a rigid cast or a splint
used to treat rather than to move someone, or physical therapy are medical treatment, and any one of
them makes the case recordable. A tetanus shot at the clinic is still first aid, not medical treatment.
Restock it before the end of the shift and note it as a corrective action. An empty kit found after
the next injury is the finding that turns one incident into a citation.
Sending them to a clinic or ER? Print the clinic packet and send it with the employee. It tells the clinic
to bill workers' comp instead of personal insurance, gives them the job's physical demands so the
restrictions come back usable, and says where to send their work status report.
California: the DWC-1 claim form must be given to the employee within one working day of learning of a work-related injury or illness that causes lost time beyond the shift or requires treatment beyond first aid — whether or not you think the injury is work-related. Log the date you provided it.
The employee completes fields 1–9. You complete 10–19 — including the date you first knew of the injury, the date you handed over the form, and the date you got it back. Those three dates are the record that you met the deadline.
What counts as “first aid”? — the list is closed
Only these fourteen count as first aid. Anything else a provider does is medical treatment, and medical
treatment makes the case recordable — even if it happened once and the employee went straight back to work.
Non-prescription medicine at non-prescription strength
Tetanus shot
Cleaning, flushing or soaking a surface wound
Bandages, gauze, butterfly bandages, Steri-Strips
Hot or cold therapy
Non-rigid support — elastic bandage, wrap, non-rigid back belt
Temporary splint or sling used only to move them
Drilling a nail to relieve pressure, or draining a blister
Eye patch
Flushing or swabbing something out of an eye
Removing a splinter with tweezers or similar
Finger guard
Massage
Drinking fluids for heat stress
Stitches, prescription medicine, a rigid cast or splint used to treat, physical therapy,
or removing something from an eye with anything more than irrigation or a swab — all medical treatment.
Override the determination — HR only
Only override when you have a reason the form cannot see — a provider's
opinion, or a carrier determination. Whatever you pick is what goes on the log.
This may be a Cal/OSHA-reportable serious injury — call, do not rely on this form. In California a fatality or a serious injury must be reported to Cal/OSHA immediately — within 8 hours; there is no 24-hour tier. Serious injury means inpatient hospitalization beyond observation or diagnostic testing, amputation, loss of an eye, or any serious degree of permanent disfigurement. Notify the Operating Administrator immediately and preserve the scene.
Damage / loss — shown because damage, theft, or a spill was selected
Item 1
The exact item goes in the RO / VIN / asset no. field and the description below.
One incident can wreck several things at once — a vehicle, the bay door it rolled into, and the tool that was under it. List each one separately so the cost and the claim can be traced to the right item.
Customer property is involved. Notify the customer before they discover it, document who called and when, and route the estimate through the Operations Manager. Do not commit to repairs, credits, or fault on the phone.
Statements & signatures
Purpose of this report. This form records the facts of a workplace event so that hazards can be corrected and any claim can be handled properly. It is a factual record, not a disciplinary action and not a finding of fault. Signing it confirms the account above was reviewed — it is not an admission of responsibility by anyone. Retaliation against an employee for reporting an injury, hazard, or near miss is prohibited by law and by company policy.
Signatures are collected in ink on the printed copy — never typed.
Incident records
Every filed report, and what it still needs. The signed copy comes first: the report downloads
when it is submitted, the manager and the employee sign it in ink, and it is uploaded here. Until that
upload lands the record shows Signed copy outstanding.
The follow-up is the rest of the work — root cause, corrective action,
whether the fix was confirmed, treatment result, claim number, OSHA determination — filled in from
Update as the answers arrive. A record closes when nothing is outstanding.
Enter your PIN on the Incident report tab to see your records.
Date
File No.
Employee
Location
Type
Severity
Status
Outstanding
Update—
Fill in what has become known since the report was filed. The account of what happened is
not editable here — if that was wrong, use Revise instead. Every change is logged with
its old value, who changed it and when.
Photos, the clinic's work status report, an estimate, a statement?
Attach them to this record — nothing here is lost while you do.
Part 2 — analysis
A fix written in a box is a plan. This line is the record that somebody went back and
checked it — which is what the state's injury and illness prevention rule asks you to keep.
The record stays open until this is answered.
Outcomes as they arrive
The report was signed in ink when it was filed. What is written
here joins that record — use Print report on the row if the file needs a copy with the follow-up on it.
Upload photos or documents to—
Choose files or drag & drop here
Scene photos, signed copy, statements, estimates, medical paperwork · Images, PDF, or Word · up to 15 MB total
Complete this report and submit — it routes to HR-06 for review. Printing and signing happen after the follow-up is finished.
Incident reporting guidelines
Incident reporting — the 7 steps
Report every event — injury, damage, near miss, and hazard. A near miss is a free lesson; the same conditions produce an injury next time. Reporting is never grounds for discipline, and retaliation for reporting is prohibited.
Make it safe first. Care for anyone hurt, stop the work, secure the area, tag out the equipment, contain the spill. The form waits — people don't.
Call for the serious ones, don't just type. Fatality, hospitalization, amputation, loss of an eye, fire, or a significant spill: call HR and the Operating Administrator now. The Cal/OSHA deadline is 8 hours for a fatality and for a serious injury alike — hospitalization, amputation, loss of an eye, or serious permanent disfigurement.
Photograph before you clean up. Wide shot, medium shot, close-up — the scene, the equipment, the damage, and the surrounding conditions. Photos attach on the Documents tab and combine into one PDF.
Unlock and document the facts. Enter your PIN, then record what happened in sequence: what was being done, what went wrong, what resulted. Dates, places, equipment, actions — no opinions and no conclusions about fault.
Get the account while it's fresh. Same day if you can. Print the report, review it with the people involved, and collect statements and signatures in ink. Declined to sign? Note it and have a witness sign.
Upload the signed copy and the photos. Documents tab → find the record → Upload. Estimates, medical paperwork, and police reports go there too.
Close the loop on the fix. Set a verification review date; you'll get an 8am reminder that day. Log what was actually done — that's what turns the record green and what an inspector asks to see.
DO
Report the same day — memory and evidence both decay.
Describe conditions and actions, not character.
Give the DWC-1 within one working day when treatment goes beyond first aid.
Keep the damaged part or equipment until told otherwise.
Fix the system — guarding, procedure, training, housekeeping.
DON'T
Don't discourage a report or suggest someone "wait and see".
Don't admit fault or promise payment to a customer or third party.
Don't write "careless", "horseplay", or "should have known" — describe what happened.
Don't clean up or repair before photographing.
Don't guess at a medical diagnosis or an OSHA determination — record what you observed.
Fatality, inpatient hospitalization, amputation, loss of an eye, structure fire, or a reportable chemical release: call HR and the Operating Administrator immediately — before completing this form.
This report is a factual record, not a disciplinary action. If conduct also warrants discipline, that is a separate HR-04 submission.