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Work Injury Incident Report (Kenya)

Work Injury Incident Report (Kenya)

WORK INJURY INCIDENT REPORT

Work Injury Benefits Act No. 13 of 2007 — Section 22 | Occupational Safety and Health Act No. 15 of 2007 — Section 26

To be filed with the Directorate of Occupational Safety and Health Services (DOSH) within 24 hours of the accident

Report completed by: [Report Completed By]

Date of report: [Report Date]

SECTION 1 — EMPLOYER DETAILS

Employer name: [Employer Name]

Business address: [Employer Address]

BRS registration number: [Employer BRS Number]

KRA PIN: [Employer KRA PIN]

Nature of industry: [Industry Type]

Total employees at this workplace: [Total Employees]

WIBA insurer: [WIBA Insurer]

WIBA policy number: [WIBA Policy Number]

SECTION 2 — INJURED WORKER DETAILS

Full name: [Worker Name]

NIC number: [Worker NIC Number]

Date of birth: [Worker DOB]

Gender: [Worker Gender]

Job title and department: [Worker Job Title]

Employment type: [Employment Type]

Date of commencement of employment: [Employment Start Date]

Normal monthly earnings: [Worker Monthly Earnings]

NSSF membership number: [Worker NSSF Number]

SECTION 3 — ACCIDENT DETAILS

Date of accident: [Accident Date]

Time of accident: [Accident Time]

Location within workplace: [Accident Location]

Task being performed: [Task At Accident]

Description of how the accident occurred:

[Accident Description]

Immediate cause: [Immediate Cause]

Root / underlying cause: [Root Cause]

Witnesses: [Witness Names]

SECTION 4 — INJURY AND MEDICAL TREATMENT

Part of body injured: [Body Part Injured]

Nature of injury: [Nature Of Injury]

Classification of injury (Second Schedule, WIBA): [Injury Classification]

Hospital / clinic: [Hospital Name]

Treating doctor (KMPDC Reg. No.): [Doctor Name]

Hospitalised: [Hospitalised]

SECTION 5 — IMMEDIATE ACTIONS AND CORRECTIVE MEASURES

Immediate actions taken:

[Immediate Actions]

Corrective actions to prevent recurrence:

[Corrective Actions]

SECTION 6 — DECLARATION

The undersigned declare that the information provided in this Work Injury Incident Report is accurate and complete to the best of their knowledge, and that this report has been filed with the Directorate of Occupational Safety and Health Services (DOSH) at [DOSH Regional Office] within 24 hours of the accident as required by Section 22 of the Work Injury Benefits Act No. 13 of 2007.

The WIBA insurer ([WIBA Insurer], Policy No. [WIBA Policy Number]) has also been notified of this accident simultaneously with this DOSH notification, in accordance with the terms of the WIBA policy.

Safety and Health Officer: [Safety Officer Name]

Authorised Employer Representative

________________

Signature

Safety and Health Officer

________________

Signature

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

What Is a Work Injury Incident Report (Kenya)?

A Work Injury Incident Report in Kenya organises the details a party must supply for the purpose it serves.

The Occupational Safety and Health Act No. 15 of 2007 (OSHA), also administered by DOSH under the Ministry of Labour and Social Protection, independently requires employers to notify DOSH of dangerous occurrences, near-misses, and occupational diseases under Section 26 of OSHA. An employer who operates a factory, construction site, mine, agricultural estate, or any other workplace with more than 20 employees must also have a registered Safety and Health Committee under Section 13 of OSHA, which is responsible for investigating accidents and preparing internal incident reports.

The dual reporting framework under the Work Injury Benefits Act No. 13 of 2007 and the Occupational Safety and Health Act No. 15 of 2007 means that a single serious workplace accident typically generates two distinct official reports: the WIBA Section 22 accident notification to DOSH (triggering the compensation process) and the OSHA Section 26 dangerous occurrence or disease notification (triggering the safety investigation process). A thorough Work Injury Incident Report addresses both requirements in a single document.

The Kenya National Industrial Training Authority (NITA) requires employers in certain sectors to maintain accident records as part of their training and safety management systems. The Factories and Other Places of Work Act Cap. 514, now substantially superseded by OSHA, historically required a register of accidents to be kept on premises — a requirement carried forward by OSHA regulations.

The Work Injury Benefits Act No. 13 of 2007 Section 5 requires employers to insure all employees with a WIBA-compliant insurance policy authorised by the Insurance Regulatory Authority (IRA). When an accident occurs and is reported to DOSH, the employer must simultaneously notify the WIBA insurer to trigger the claims process. Most WIBA insurers require a copy of the employer's Work Injury Incident Report as part of the claims documentation.

The National Environment Management Authority (NEMA), established under the Environment Management and Co-ordination Act No. 8 of 1999, may also require notification of incidents involving hazardous substances or environmental damage — relevant for chemical spills, industrial fires, or accidents at extractive industry sites. A well-prepared Work Injury Incident Report that documents the full facts of the accident assists the employer in responding to all relevant regulatory authorities from a single source of truth.

The Employment and Labour Relations Court (ELRC) has held in several decisions that an employer's prompt, accurate, and complete incident reporting demonstrates reasonable conduct — while delayed, incomplete, or falsified reports can be treated as evidence of negligence or bad faith in contested WIBA or common law proceedings.

When Do You Need a Work Injury Incident Report (Kenya)?

A Work Injury Incident Report in Kenya is required by law within 24 hours of any workplace accident that results in death, permanent disablement, temporary disablement of more than 3 days, or the contraction of an occupational disease listed in the Third Schedule to the Work Injury Benefits Act No. 13 of 2007.

A Work Injury Incident Report is needed when a worker on a road construction site in Mombasa is struck by a reversing vehicle and sustains a broken pelvis. The employer must file the DOSH notification within 24 hours under Section 22 of the Work Injury Benefits Act No. 13 of 2007, simultaneously notify the WIBA insurer, and initiate an internal safety investigation under the Occupational Safety and Health Act No. 15 of 2007.

A Work Injury Incident Report is required when a laboratory technician in a Nairobi hospital suffers a needlestick injury during a blood sample procedure. Even if the injury appears minor, the risk of blood-borne disease transmission means DOSH notification is required under both WIBA and OSHA, and the hospital's infection control and occupational health procedures must be activated.

A Work Injury Incident Report is needed when a security guard employed by a private security firm is assaulted and injured while on duty at a client's premises. The Security Industry Act No. 14 of 2013 and the WIBA both apply, and the employer — the security firm, not the client — must file the incident report and the WIBA notification.

A Work Injury Incident Report is required when an employee in a tea-processing factory in Kericho is diagnosed with occupational hearing loss after years of exposure to machinery noise exceeding 85 decibels. Occupational diseases under the Third Schedule to the Work Injury Benefits Act No. 13 of 2007 must be reported to DOSH on diagnosis, even where the causative exposure occurred over a prolonged period.

A Work Injury Incident Report is needed when a software developer who works from home under a remote work arrangement falls and fractures a wrist while walking from their workstation during working hours. The Work Injury Benefits Act No. 13 of 2007 covers accidents arising out of and in the course of employment, and there is developing DOSH guidance on home-working accidents — employers should report and let DOSH assess whether the accident falls within the Act's scope.

A Work Injury Incident Report is required when a fatal accident occurs at an agricultural estate, mine, or industrial plant — triggering not only the 24-hour DOSH notification under WIBA Section 22 but also a potential investigation by the Directorate of Criminal Investigations (DCI) and a coroner's inquest under the Inquests Act Cap. 68.

What to Include in Your Work Injury Incident Report (Kenya)

A Kenya Work Injury Incident Report compliant with the Work Injury Benefits Act No. 13 of 2007 Section 22 and the Occupational Safety and Health Act No. 15 of 2007 must contain the following essential elements.

Employer Identification: Full legal name of the employer; business address and physical location of the workplace where the accident occurred; Business Registration Service (BRS) registration number; KRA PIN; nature of the industry or business; total number of employees at the workplace; name, designation, and contact details of the person completing the report; and WIBA insurance policy number and insurer name as required by Section 5 of the Work Injury Benefits Act No. 13 of 2007.

Injured Worker Details: Full name; National Identity Card (NIC) number; date of birth; gender; job title and department; type of employment (permanent, casual, seasonal, or apprentice); date of commencement of employment; normal monthly earnings (used to calculate WIBA compensation under the Second Schedule); and NSSF membership number.

Accident Details: Exact date and time of the accident; precise location within the workplace (building, floor, workstation, open yard, or road); task being performed by the worker at the time of the accident; sequence of events leading to the accident described in chronological order; the immediate cause of the accident (equipment failure, human error, environmental hazard, or other); and the underlying or root cause where ascertainable at the time of initial report.

Injury Description: Part of the body injured; nature of the injury (fracture, laceration, burn, crush injury, chemical exposure, or occupational disease); classification of the injury — fatal, permanent total disablement, permanent partial disablement, or temporary total disablement as defined in the Second Schedule to the Work Injury Benefits Act No. 13 of 2007; name of the hospital or clinic where the worker was treated; name and KMPDC registration number of the treating medical practitioner; and whether the worker was hospitalised.

Witness Information: Names, job titles, and contact details of all witnesses to the accident. Witness statements should be taken as soon as practicable and attached to the report.

Immediate Actions Taken: First aid administered, emergency services contacted, unsafe area cordoned off, damaged equipment isolated, and any other immediate corrective measures taken after the accident.

Root Cause Analysis and Corrective Actions: Preliminary assessment of the factors contributing to the accident — inadequate training, absence of personal protective equipment (PPE), machinery malfunction, failure to follow the Safe Work Procedure (SWP), or lack of adequate supervision. Corrective actions proposed or already implemented to prevent recurrence, with responsible persons and target dates.

Declaration: The employer's authorised signatory declares that the information is accurate and complete to the best of their knowledge, and that the report has been filed with the DOSH regional office within 24 hours of the accident as required by Section 22 of the Work Injury Benefits Act No. 13 of 2007. The Safety and Health Officer's countersignature should appear where the employer has a registered Safety and Health Committee under Section 13 of OSHA. The forms-legal.com Kenya Work Injury Incident Report template meets all DOSH mandatory fields and includes guidance notes on each section to help employers complete the report accurately under time pressure.

Additional compliance elements for a Work Injury Incident Report (Kenya) used in Kenya include: Under the Employment Act No. 11 of 2007, the Employment and Labour Relations Court (ELRC) adjudicates workplace disputes in Kenya. Section 35 of the Employment Act 2007 governs termination of employment. The National Social Security Fund Act No. 45 of 2013 mandates employer contributions to NSSF. The Social Health Insurance Fund (SHIF) replaced NHIF in 2024. The Kenya Revenue Authority (KRA) administers PAYE under the Income Tax Act (Cap. 470). Forms-legal.com provides this template as a starting point for Kenya-compliant documentation.

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

APA

Forms Legal. (2026). Work Injury Incident Report (Kenya) (Kenya) [Legal document template]. Forms Legal. https://forms-legal.com/kenya/employment/health-safety/work-injury-incident-report-kenya

MLA

"Work Injury Incident Report (Kenya) (Kenya)." Forms Legal, 2026, https://forms-legal.com/kenya/employment/health-safety/work-injury-incident-report-kenya.

BibTeX
@misc{formslegal-work-injury-incident-report-kenya,
  author       = {{Forms Legal}},
  title        = {Work Injury Incident Report (Kenya) (Kenya)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/kenya/employment/health-safety/work-injury-incident-report-kenya}},
  note         = {Free legal document template}
}

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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