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This document is used to report injuries or illnesses sustained by employees, specifically within the context of workers' compensation for the State of Arizona. It captures essential details about

How to fill out supervisors report of injury

How to fill out Supervisor's Report of Injury / Illness (SRI)

1. Obtain the Supervisor's Report of Injury / Illness (SRI) form.
2. Fill in the date of the incident at the top of the form.
3. Provide the name and contact information of the injured party.
4. Describe the nature of the injury or illness, including specific details.
5. Indicate the location where the incident occurred.
6. Note the circumstances surrounding the incident, including any contributing factors.
7. List any witnesses to the event, along with their contact information.
8. Provide any immediate actions taken after the incident, such as first aid administered.
9. Sign and date the report to ensure accountability.
10. Submit the completed form to the appropriate department following company procedures.

Who needs Supervisor's Report of Injury / Illness (SRI)?

1. Supervisors responsible for overseeing employee safety.
2. Human Resources personnel handling employee injury or illness cases.
3. Insurance representatives for processing claims related to workplace injuries.
4. Legal teams for ensuring compliance with workplace injury regulations.

People Also Ask about

Which item should be included in a supervisor's report of employee injury?

Fractures: Any broken bone, no matter how small, should be reported immediately. Burns: All burns, including minor ones, should be documented, especially if they occur due to workplace hazards. Muscle Strains: Injuries like back strains or other muscle injuries that cause pain or limit mobility should be reported.

What is the first thing a supervisor should do when an injury is reported?

Such report shall state the name and nature of the business of the employer, the location of its establishment or place of work, the name, address and occupation of the injured employee, the time, nature and cause of the injury and such other information as may be required by the chair.

What is the first action you should take to help an injured colleague?

Ensuring Immediate Medical Attention When a workplace injury occurs, the foremost priority is ensuring that the injured individual receives immediate medical attention. This critical step is vital not only for the wellbeing of the injured party but also for the integrity of the workplace.

What type of injuries must be reported to your supervisor?

After the injury, go directly to your supervisor or boss and tell them exactly what happened. You can tell your boss in person, if you are in the same location, or over the phone if you're in a different location. You'll want to tell them the order of events and the names of anyone who saw the injury occur.

What is the first thing that must be done when a worker is injured?

If your employee has a work-related injury or illness, you should seek medical care for them. Your employee should file a report with the company to start the workers' compensation process. After getting their report, you can start documenting and gathering information about their injury or illness.

What is the first thing you should do if you see someone get injured at work?

Seek Medical Attention The very first thing as an employer that you should do is to make sure that the injured employee gets the proper medical attention. So that they can get better. For major injuries, seek immediate medical care and call ambulance helpline no- 102 to get assistance.

What is the first thing we should do when a person is injured?

Cleanse area thoroughly with soap and warm water, carefully washing away any dirt. Apply direct pressure to wound until bleeding stops. Put sterile bandage on wound. If cut is deep, get to a doctor as quickly as possible.

For pdfFiller’s FAQs

What is Supervisor's Report of Injury / Illness (SRI)?

The Supervisor's Report of Injury / Illness (SRI) is a document used to officially record and report an injury or illness that occurs in the workplace. It provides critical information for both medical evaluation and workplace safety analysis.

Who is required to file Supervisor's Report of Injury / Illness (SRI)?

The supervisor or manager of the employee who sustained the injury or illness is required to file the Supervisor's Report of Injury / Illness (SRI). This ensures that the incident is documented correctly and that appropriate measures can be taken.

How to fill out Supervisor's Report of Injury / Illness (SRI)?

To fill out the Supervisor's Report of Injury / Illness (SRI), the supervisor should provide details about the incident, including the date and time of the injury, the descriptions of what happened, any witnesses, the nature of the injury or illness, and the actions taken after the incident.

What is the purpose of Supervisor's Report of Injury / Illness (SRI)?

The purpose of the Supervisor's Report of Injury / Illness (SRI) is to document incidents of workplace injuries or illnesses for record-keeping, to comply with legal and regulatory requirements, and to analyze incidents to improve workplace safety.

What information must be reported on Supervisor's Report of Injury / Illness (SRI)?

The information that must be reported on the Supervisor's Report of Injury / Illness (SRI) includes the employee's name, date and time of the incident, nature and details of the injury or illness, location of the incident, names of any witnesses, and actions taken in response to the incident.