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Submit a Severe Injury/Illness Report

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 an email response from MIOSHA containing 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 at 517-284-7788.