This cohort study, conducted in an Australian hospital, reports on the implementation of an incident reporting system within an existing anesthesia electronic medical record. Anesthesiologists were required to document any adverse events, in one of 16 predefined categories, as part of their routine clinical documentation. Acceptance of the system was high, and the vast majority of reported adverse events were confirmed by chart review. As prior research has shown that incident reporting systems suffer from low physician reporting rates, integration of incident reporting into routine electronic documentation may help increase physician reports of errors.