• May include: A white paper incident report form with black text on a dark background. The form includes sections for reporting injuries, near misses, OSHA 8-hour and 24-hour reporting clocks, and a chain of calls. The header reads Jobsite Form.
  • May include: A white incident report form titled When somebody gets hurt, or almost does. It includes a table for OSHA 1904.39 reporting requirements, sections for incident procedures, and blank fields for recording date, time, employer, and injury details.
  • May include: A white paper incident report form with black text on a dark background. The form includes sections for reporting injuries, near misses, OSHA 8-hour and 24-hour reporting clocks, and a chain of calls. The header reads Jobsite Form.
  • May include: A white incident report form titled When somebody gets hurt, or almost does. It includes a table for OSHA 1904.39 reporting requirements, sections for incident procedures, and blank fields for recording date, time, employer, and injury details.
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Construction Incident Report Form | Accident and Near Miss Report with OSHA 1904.39 Reporting Clock | Printable Jobsite PDF

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  • Digital file type(s): 1 PDF
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“Good content in both English and Spanish.”

E

Aug 21, 2026

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Price:$4.00

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May include: A white paper incident report form with black text on a dark background. The form includes sections for reporting injuries, near misses, OSHA 8-hour and 24-hour reporting clocks, and a chain of calls. The header reads Jobsite Form.

One page that does the job the night somebody gets hurt: the OSHA reporting clock, your chain of calls, and the incident record, all on the same sheet.

Most outfits find out what 1904.39 requires after the fact. A death from a work incident has to be reported to OSHA within 8 hours. An in-patient hospitalization, amputation, or loss of an eye within 24 hours. Missing the window is its own citation, separate from whatever caused the injury. This form puts the clock, the number, and what to have ready in a table at the top so the foreman isn't searching for it at 7 p.m.

WHAT'S ON THE PAGE:
- The 1904.39 reporting table: what happened, report within, how, with the OSHA number and what they'll ask
- Lines for who in your company makes the OSHA call and the GC's incident line
- Your chain, every time: help first, scene safe, foreman calls office and GC, write it down same day, find the cause, near misses get the same write-up
- The incident record: date and time, who was hurt or nearly was, employer, what happened in plain words, injury and treatment, witnesses, what caused it and what we changed, investigated by, sent to GC on
- A note on recordkeeping (300 log, 301, 300A posting) and who it applies to

Use it for near misses too. They're free lessons and the GC will ask for them.

US Letter, prints clean in grayscale. Instant download. One purchase covers your company; print all you need.

This page is Section 10 of the Site-Specific Safety Plan sold in this shop. Buy that if you need the whole plan.

Written by a working steel erector. Training aid, not legal advice. It supports your company's safety program and current OSHA standards, it doesn't replace them. State-plan states may have tighter clocks; check yours. Digital product, no refunds on digital files, but if something's wrong with your file, message me and I'll make it right.

  • Designed by
    ToolboxYear
  • Item type
    Digital download
  • Digital file type(s)
    1 PDF
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