Get the free Employee Injury or Illness Report Form - unco

This form is used to report any injury or illness that an employee has experienced while working, detailing the circumstances of the incident and supporting information.

How to fill out employee injury or illness

How to fill out Employee Injury or Illness Report Form

1. Obtain the Employee Injury or Illness Report Form from your workplace's safety officer or human resources.
2. Fill in the employee's name, job title, and department at the top of the form.
3. Provide the date and time of the injury or illness occurrence.
4. Describe the specific location where the injury or illness happened.
5. Detail the nature of the injury or illness, including any symptoms experienced.
6. List any witnesses to the incident, if applicable.
7. Include any immediate actions taken following the injury or illness.
8. Sign and date the form to verify the information provided.
9. Submit the completed form to your supervisor or human resources department.

Who needs Employee Injury or Illness Report Form?

1. Employees who sustain an injury or illness related to their work.
2. Supervisors or managers who need to document workplace incidents.
3. Human resources personnel responsible for maintaining employee records.
4. Occupational health and safety officers for compliance and reporting purposes.

People Also Ask about

What is the form for employee illness reporting?

Complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable, call your local OSHA office for help. Feel free to use two lines for a single case if you need to.

How does a company handle employee illness?

There is no guaranteed perfect way to treat employees with serious health problems. The keys are recognizing there is an issue, applying all of the applicable laws to the situation, attempting to work with the employee throughout the process and documenting everything as accurately as possible.

What must be true for an employer to record an injury or illness?

Injury & Illness Recordkeeping Forms - 300, 300A, 301.

What is the OSHA log 200 form?

The OSHA 200 log refers to the Occupational Safety and Health Administration (OSHA) Form 200, also known as the Log and Summary of Occupational Injuries and Illnesses. The OSHA 200 log is a standardized form used by employers to record and track workplace injuries and illnesses.

What is the difference between OSHA 300 and 301 forms?

You must use OSHA 300, 300-A, and 301 forms, or equivalent forms, for recordable injuries and illnesses. The OSHA 300 form is called the Log of Work-Related Injuries and Illnesses, the 300-A is the Summary of Work-Related Injuries and Illnesses, and the OSHA 301 form is called the Injury and Illness Incident Report.

What is the OSHA 300A form?

The Summary — a separate form (Form 300A) — shows the totals for the year in each category. At the end of the year, post the Summary in a visible location so that your employees are aware of the injuries and illnesses occurring in their workplace. Employers must keep a Log for each establishment or site.

For pdfFiller’s FAQs

What is Employee Injury or Illness Report Form?

The Employee Injury or Illness Report Form is a document used by employees to report any injuries or illnesses that occur in the workplace. It serves as a formal record of the incident.

Who is required to file Employee Injury or Illness Report Form?

Any employee who experiences an injury or illness related to their work is required to file the Employee Injury or Illness Report Form, typically within a specified time frame after the incident.

How to fill out Employee Injury or Illness Report Form?

To fill out the form, the employee should provide details such as the date and time of the incident, the nature of the injury or illness, how it occurred, any witnesses, and the treatment received, if applicable.

What is the purpose of Employee Injury or Illness Report Form?

The purpose of the form is to document workplace injuries and illnesses for record-keeping, to comply with legal requirements, and to help identify and mitigate workplace hazards.

What information must be reported on Employee Injury or Illness Report Form?

The form must report information including the employee's name, job title, date of birth, date and time of the incident, a description of the injury or illness, the circumstances leading to it, and any immediate medical treatment received.