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Workplace Accident Report Form (Ghana)

Workplace Accident Report Form (Ghana)

Workplace Accident Report Form

WORKPLACE ACCIDENT REPORT FORM — GHANA

Prepared pursuant to Section 41 of the Factories Offices and Shops Act 1970 (Act 328) and the Workmen's Compensation Law 1987 (PNDC Law 187).

Date of Report: [Report Date]

1. Employer and Workplace Details

1.1

Employer / Company Name: [Employer Name]

1.2

ORC Company Registration Number: [Employer Reg Number] | TIN: [Employer TIN]

1.3

Workplace Address: [Workplace Address]

1.4

Type of Workplace: [Workplace Type]

1.5

Report Completed By: [Safety Officer Name]

2. Injured Worker Details

2.1

Worker Name: [Worker Name]

2.2

Job Title: [Worker Job Title] | Department: [Worker Department]

2.3

Residential Address: [Worker Address]

2.4

SSNIT Number: [Worker SSNIT Number] | Length of Service: [Worker Length Of Service]

3. Accident Details

3.1

Date of Accident: [Accident Date] | Time: [Accident Time]

3.2

Location within Workplace: [Accident Location]

3.3

Description of Accident: [Accident Description]

3.4

Task Being Performed: [Task At Time Of Accident]

3.5

PPE in Use at Time of Accident: [PPE In Use]

4. Nature of Injury

4.1

Type of Injury: [Injury Type]

4.2

Body Part(s) Affected: [Body Part Affected]

4.3

Estimated Period of Incapacity: [Incapacity Duration]

4.4

Hospital / Clinic: [Hospital Name]

5. Causes and Corrective Actions

5.1

Immediate Cause: [Immediate Cause]

5.2

Root Cause(s): [Root Cause]

5.3

Corrective and Preventive Actions: [Corrective Actions]

5.4

Date Reported to Chief Inspector of Factories (DFI): [DFI Report Date] | DFI Reference: [DFI Reference Number]

Signatures

This Workplace Accident Report Form has been completed in accordance with Section 41 of the Factories Offices and Shops Act 1970 (Act 328) and the Workmen's Compensation Law 1987 (PNDC Law 187). The information recorded is accurate and complete to the best of the knowledge of the persons signing below.

Employer / Safety Officer

________________

Signature

Injured Worker (or representative)

________________

Signature

Maintained by Vladislav Sergienko, Founder·Template last modified: ·Report an error

What Is a Workplace Accident Report Form (Ghana)?

A Workplace Accident Report Form in Ghana records the particulars required for the matter it documents.

Section 41 of the Factories Offices and Shops Act 1970 (Act 328) imposes a duty on the occupier of a factory, office, or shop to report to the Chief Inspector of Factories any accident that causes the death of a worker or renders any person incapable of work for more than three days. The Chief Inspector of Factories is appointed under Section 35 of Act 328 and operates within the Department of Factories Inspectorate (DFI), a division of the Ministry of Employment and Labour Relations. Failure to report a notifiable accident is an offence under Section 70 of Act 328 and may result in prosecution before the District Court.

The Labour Act 2003 (Act 651) complements Act 328 by imposing a general duty on employers to provide a safe and healthy working environment for all workers, and by requiring employers to comply with health and safety regulations issued by the Minister of Employment and Labour Relations. Section 118 of Act 651 requires every employer to take measures to prevent work-related accidents, diseases, and injuries. The National Labour Commission (NLC) established under Part XV of Act 651 may hear complaints from workers about failure to comply with safety obligations.

The Workmen's Compensation Law 1987 (PNDC Law 187) imposes strict liability on employers in Ghana for injuries, diseases, and death arising from employment. Under PNDC Law 187, an employer is liable to pay compensation regardless of fault when a worker is injured or contracts a disease in the course of and arising from employment. The compensation amounts under PNDC Law 187 — which are periodically revised by the Ministry of Employment and Labour Relations — cover temporary incapacity, permanent partial incapacity, permanent total incapacity, and death. A properly completed Workplace Accident Report Form is the foundational document for processing a compensation claim under PNDC Law 187 and for any subsequent investigation by the Department of Factories Inspectorate.

The Workplace Accident Report Form in Ghana must be distinguished from the Personal Accident Claim Form (gh-accident-claim-form), which is directed to a private insurer under a personal accident insurance policy governed by the Insurance Act 2006 (Act 724). Both forms may be required where a worker is injured at the workplace and the employer carries group personal accident insurance through an NIC-licensed insurer.

When Do You Need a Workplace Accident Report Form (Ghana)?

A Workplace Accident Report Form in Ghana is required in the following circumstances.

The Form is required immediately whenever a worker is injured, killed, or suffers an occupational disease at any factory, office, shop, or other workplace in Ghana covered by the Factories Offices and Shops Act 1970 (Act 328). Under Section 41 of Act 328, the occupier must report to the Chief Inspector of Factories within 24 hours of any accident causing death, and within 7 days for accidents rendering a person incapable of work for more than three days.

The Form is required before an employer in Ghana can process a workmen's compensation claim under the Workmen's Compensation Law 1987 (PNDC Law 187). The Department of Factories Inspectorate requires a completed accident report as the basis for assessing the employer's liability and the quantum of compensation payable to the injured worker or their dependants.

The Form is needed to comply with the employer's health and safety obligations under Section 118 of the Labour Act 2003 (Act 651), which requires employers to investigate workplace accidents and implement corrective measures. A documented investigation record demonstrates good faith compliance with Act 651 and reduces the employer's exposure in proceedings before the National Labour Commission (NLC) or the High Court (Labour Division).

The Form is required where a worker has suffered an injury and intends to claim under a group personal accident insurance policy maintained by the employer through an NIC-licensed insurer. The insurer will require the completed Workplace Accident Report Form as supporting evidence for the claim under Section 40 of the Insurance Act 2006 (Act 724).

The Form is needed when an accident at a construction site in Ghana is reportable under both the Factories Offices and Shops Act 1970 (Act 328) and the regulations of the Ghana National Fire Service Act 1997 (Act 537), where fire or explosion was a contributing cause.

Parties in Ghana should complete the Workplace Accident Report Form as soon as possible after any workplace accident, retaining copies on the employer's occupational health and safety register and providing a copy to the injured worker under the Labour Act 2003 (Act 651).

What to Include in Your Workplace Accident Report Form (Ghana)

A valid Workplace Accident Report Form in Ghana under the Factories Offices and Shops Act 1970 (Act 328) and the Workmen's Compensation Law 1987 (PNDC Law 187) must contain the following essential elements.

Employer and Workplace Details: Full legal name of the employer, company registration number issued by the Office of the Registrar of Companies (ORC) under the Companies Act 2019 (Act 992), Tax Identification Number (TIN) issued by the Ghana Revenue Authority (GRA), address and nature of the workplace (factory, office, shop, or construction site), and the name of the occupier as defined in Section 2 of the Factories Offices and Shops Act 1970 (Act 328). The employer's SSNIT employer registration number should also be recorded to support workmen's compensation processing.

Injured Worker Details: Full name, date of birth, home address, job title, department, SSNIT number, and the length of service of the injured worker. The worker's nationality and work permit details (if an expatriate employed under the Immigration Act 2000 (Act 573)) should also be recorded. The worker's SSNIT number is required to process invalidity benefit claims under the National Pensions Act 2008 (Act 766).

Accident Details: Date (DD/MM/YYYY), time, and precise location within the workplace where the accident occurred; a factual description of the sequence of events leading to the accident; the task the worker was performing at the time; and whether any personal protective equipment (PPE) was being used as required under Act 328.

Nature of Injury: Type of injury (fracture, laceration, burn, crush, amputation, poisoning, etc.), the body part or parts affected, whether the injury was fatal, and the initial medical assessment. Where the injury involved an occupational disease listed in the Schedule to PNDC Law 187, this must be specifically identified.

Immediate Cause and Root Cause: The immediate physical cause of the accident (e.g. Unguarded machinery, spillage, falling object) and the underlying root causes (e.g. Absence of risk assessment, inadequate training, failure to maintain equipment as required under Section 12 of Act 328).

Medical Treatment: Name and address of the hospital or clinic (licensed by the Ghana Health Service) where the worker was treated, the date treatment was first provided, the name of the attending physician, and whether the worker was admitted or treated as an outpatient. Treatment costs in GHS should be documented for workmen's compensation purposes under PNDC Law 187.

Witnesses: Full names and contact details of all persons who witnessed the accident or who were present at the workplace at the time.

Corrective Actions: A description of the immediate corrective actions taken following the accident (e.g. Isolation of equipment, removal of hazard) and the longer-term preventive measures planned to avoid recurrence, consistent with the employer's duties under Section 118 of the Labour Act 2003 (Act 651). Corrective actions must be documented and reviewed by the employer's safety committee, where one exists under Act 328.

Reporting to Authorities: Confirmation of whether the accident has been reported to the Chief Inspector of Factories under Section 41 of Act 328, together with the date of notification and the reference number of the DFI report. Forms-legal.com provides this template as a starting point for Ghana-compliant workplace safety documentation.

Signatures: The form must be signed by the employer or the employer's designated safety officer, and countersigned by the injured worker (or their representative if incapacitated). The date of the report and the name of the person completing the form must be clearly stated. A copy must be retained on the employer's occupational health and safety register under the Labour Act 2003 (Act 651).

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Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Workplace Accident Report Form (Ghana) (Ghana) [Legal document template]. Forms Legal. https://forms-legal.com/ghana/employment/health-safety/workplace-accident-report-form-ghana

MLA

"Workplace Accident Report Form (Ghana) (Ghana)." Forms Legal, 2026, https://forms-legal.com/ghana/employment/health-safety/workplace-accident-report-form-ghana.

BibTeX
@misc{formslegal-workplace-accident-report-form-ghana,
  author       = {{Forms Legal}},
  title        = {Workplace Accident Report Form (Ghana) (Ghana)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/ghana/employment/health-safety/workplace-accident-report-form-ghana}},
  note         = {Free legal document template}
}

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Frequently Asked Questions

Statute-referenced template — Template last modified June 2026

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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