Form 109 – Application for Self Insurance
160 East 300 South, 3rd Floor
Salt Lake City, UT 84114-6600
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(801) 530-6800
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To report an Imminent Danger, call
(801) 530-6901 or (800) 530-5090 immediately.
To Report an Accident, click the button below.
An employer must report an accident within eight hours of it’s occurrence. See Utah Admin. Code Rule R614-1-5)(B)(1).
To file a complaint that is not an imminent danger or accident, click File Complaint below.
*Although the complaint form references federal law, the Utah Occupational Safety and Health Division administers the Utah Occupational Safety and Health Act.
See Utah Code §§ 34A-6-101 – 34A-6-307