Kevin Ian Schmidt

Fatality, Amputation, and Hospitalization Report

OSHA has specific reporting requirements for serious injuries that occur within a facility.

The OSHA notification requirements are as follows:

  • Hospitalization: This is for a work related hospitalization, and must be reported within 24 hours;
  • Amputation: This is for a work related amputation, and must be reported within 24 hours;
  • Loss of Eye: This is for a work related loss of eye, and must be reported within 24 hours;
  • Fatality: This includes all fatalities that occur within the workplace, and must be reported within 8 hours.


Note the difference of any fatality, being required to report within 8 hours AND for ANY fatality within a workplace.

For Example: if an employee suffers a heart attack, the fatality should result in a call to OSHA.

When these incidents occur, it is a turbulent time in the workplace. Having a process in place, with a basic form, such as this report helps keep the process streamlined.

This report includes all the information OSHA requires:

  • Business name;
  • names of employees affected;
  • location and time of the incident,
  • brief description of the incident;
  • contact person and phone number.


How does OSHA define “Hospitalization”?

OSHA defines in-patient hospitalization as a formal admission to the in-patient service of a hospital or clinic for care or treatment. Treatment in an Emergency Room only is not reportable.

How does OSHA define “amputation”?

An amputation is the traumatic loss of all or part of a limb or other external body part. This would include fingertip amputations with or without bone loss; medical amputations resulting from irreparable damage; and amputations of body parts that have since been reattached. If and when there is a health care professional’s diagnosis available, the employer should rely on that diagnosis.

If a fatality occurs within 30 days of the work-related incident, or if an in-patient hospitalization, amputation, or loss of an eye occurs within 24 hours of the work-related incident, then you must report the event to OSHA.


This form is a beneficial component of a total accident investigation program. If you feel your organization needs more components of an incident investigation program, find them here.


Download and view the Amputation, Hospitalization & Fatality report form below:

Fatality Report

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