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ESI Accident Report (India)

ESI Accident Report (India)

Employees State Insurance Act 1948 — Accident Report

ACCIDENT REPORT — EMPLOYMENT INJURY

Under Section 44 of the Employees State Insurance Act 1948 and Regulation 68 of ESI (General) Regulations 1950

To

[ESIC Office]

Date of Report: [Report Date]

PART A — EMPLOYER DETAILS

Employer Name: [Employer Name]

ESIC Registration No.: [ESIC Reg Number]

Establishment Address: [Establishment Address]

PART B — INJURED EMPLOYEE DETAILS

Name: [Employee Name]

IP Number: [IP Number]

Designation / Nature of Work: [Designation]

Age: [Age]

Address: [Employee Address]

PART C — ACCIDENT DETAILS

Date and Time of Accident: [Accident Date/Time]

Location: [Accident Location]

Description of Accident: [Accident Description]

Nature of Injury / Body Part: [Injury Nature]

Severity of Injury: [Injury Severity]

Witnesses: [Witnesses]

PART D — MEDICAL TREATMENT

First Aid Given at Site: [First Aid Given]

Hospital / ESI Dispensary: [Hospital Name]

Date of Admission: [Admission Date]

Estimated Days Absent: [Days Absent]

EMPLOYER DECLARATION

I, the undersigned, being the employer / authorised representative of [Employer Name], do hereby certify that the above particulars are true and correct to the best of my knowledge. This report is submitted in compliance with Section 44 of the Employees State Insurance Act 1948 which requires the employer to report an employment injury forthwith or within 24 hours of the occurrence.

I further undertake to submit the claim form of the injured employee to the ESIC within the prescribed time and to co-operate with any inquiry into this accident.

Employer / Authorised Representative (with Seal)

________________

Signature

Supervisor / Safety Officer

________________

Signature

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What Is a ESI Accident Report (India)?

An ESI Accident Report in India sets out the particulars the recipient needs to deal with the request, in a structured and reviewable form.

The legal framework governing the ESI Accident Report (India) in India draws on several key statutes and regulatory bodies. Under Indian law, the Indian Contract Act 1872 governs contractual obligations, with Section 10 setting essential requirements for valid agreements. The Companies Act 2013 regulates corporate entities through the Registrar of Companies (ROC) and Ministry of Corporate Affairs (MCA). The Industrial Disputes Act 1947 and state labour commissioners govern employment disputes. The Information Technology Act 2000 and IT (Reasonable Security Practices) Rules 2011 protect personal data. The Income Tax Act 1961 and Goods and Services Tax Act 2017 govern tax obligations through the Central Board of Direct Taxes (CBDT) and GST Council. Parties executing a ESI Accident Report (India) in India should confirm the document reflects current law, including any amendments enacted since the original drafting date. The Industrial Disputes Act, 1947 sets the foundational requirements.

When Do You Need a ESI Accident Report (India)?

An employer covered under the Employees State Insurance Act 1948 must submit an ESI Accident Report whenever an insured employee (i.e., an employee earning up to ₹21,000 per month) sustains any form of employment injury at the workplace or while engaged in work-related activities. The report is needed regardless of the severity of the injury — even a minor injury that requires only first aid and causes no loss of work time should be documented in the Accident Register (Form 12), though formal reporting to the ESIC local office becomes mandatory where the injury results in incapacity for work. The 24-hour reporting requirement under Section 44 read with Regulation 68 of the ESI General Regulations 1950 means employers must act immediately upon an employment injury occurring. The report is particularly critical in cases of serious or fatal accidents where there may be concurrent obligations under the Factories Act 1948 (Section 88) or the Building and Other Construction Workers Act 1996. Employers also need to file accident reports in cases of occupational diseases — diseases prescribed in the Third Schedule of the ESI Act that arise from prolonged exposure to hazardous conditions at the workplace. Common occupational diseases listed include silicosis, lead poisoning, noise-induced hearing loss, and asbestosis. When an employee dies as a result of an employment injury, the accident report serves as the basis for the dependants' benefit claim under Section 52 of the ESI Act. Construction contractors and firms with contract workers also need to file accident reports if their workers are covered under the ESI scheme through the principal employer.

Parties in India should prepare a ESI Accident Report (India) proactively rather than waiting for a dispute to arise. Courts interpret agreements based on the written terms rather than oral representations. Under Indian law, the Indian Contract Act 1872 governs contractual obligations, with Section 10 setting essential requirements for valid agreements. The Companies Act 2013 regulates corporate entities through the Registrar of Companies (ROC) and Ministry of Corporate Affairs (MCA). The Industrial Disputes Act 1947 and state labour commissioners govern employment disputes. The Information Technology Act 2000 and IT (Reasonable Security Practices) Rules 2011 protect personal data. The Income Tax Act 1961 and Goods and Services Tax Act 2017 govern tax obligations through the Central Board of Direct Taxes (CBDT) and GST Council. Where the transaction involves regulated activities, prior approval from the relevant authority may be required before execution.

What to Include in Your ESI Accident Report (India)

A valid ESI Accident Report must contain several essential elements to confirm ESIC processes the claim correctly and provides timely benefits to the injured employee. The report must clearly identify the employer's ESIC registration number — the 17-digit code allotted upon registration — as this links the establishment to the ESIC records. The injured employee must be identified by their Insurance Number (IP number), which is the unique identifier assigned by ESIC to each insured person. The date, time, and exact location of the accident within the establishment must be stated precisely, as these facts determine whether the injury arose 'in the course of employment.' A clear description of how the accident occurred is essential — this narrative helps ESIC adjudicate whether the injury arose 'out of employment' (i.e., was causally connected to the work being done). The nature of the injury — which body part was affected and the type of injury (fracture, laceration, burn, crush injury, etc.) — must be described with reference to medical findings where available. The severity classification (minor, serious, dangerous, or fatal) determines the priority of response from ESIC. The names of witnesses to the accident should be recorded, as they may be required to give statements during ESIC's inquiry. Details of first aid given at the site, the hospital or ESI dispensary where the employee was taken, and the estimated duration of incapacity are required for the Corporation to calculate and process the appropriate cash benefit. The employer's authorised representative must sign the report with the company seal, confirming the accuracy of information provided.

Additional compliance elements for a ESI Accident Report (India) used in India include: Under Indian law, the Indian Contract Act 1872 governs contractual obligations, with Section 10 setting essential requirements for valid agreements. The Companies Act 2013 regulates corporate entities through the Registrar of Companies (ROC) and Ministry of Corporate Affairs (MCA). The Industrial Disputes Act 1947 and state labour commissioners govern employment disputes. The Information Technology Act 2000 and IT (Reasonable Security Practices) Rules 2011 protect personal data. The Income Tax Act 1961 and Goods and Services Tax Act 2017 govern tax obligations through the Central Board of Direct Taxes (CBDT) and GST Council. Forms-legal.com provides this template as a starting point for India-compliant documentation.

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

APA

Forms Legal. (2026). ESI Accident Report (India) (India) [Legal document template]. Forms Legal. https://forms-legal.com/india/employment/health-safety/esi-accident-report-india

MLA

"ESI Accident Report (India) (India)." Forms Legal, 2026, https://forms-legal.com/india/employment/health-safety/esi-accident-report-india.

BibTeX
@misc{formslegal-esi-accident-report-india,
  author       = {{Forms Legal}},
  title        = {ESI Accident Report (India) (India)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/india/employment/health-safety/esi-accident-report-india}},
  note         = {Free legal document template. Based on Industrial Disputes Act, 1947}
}

Frequently Asked Questions

Based on Industrial Disputes Act, 1947 — Template last modified June 2026Verify the source →

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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