Get the free Report of AccidentIllness Form - Oregon State University

Office of Human Resources, Employee Benefits, 204 Kerr Administration Building, (541) 7372805 Report of Accident/Illness Form Employee accidents: immediate Supervisor completes this form immediately.

How to fill out report of accidentillness form

How to fill out a report of accident/illness form:

1. Start by clearly stating the date and time of the accident or onset of illness. Include the exact location as well.
2. Provide your personal information, such as name, address, contact number, and employee identification number if applicable.
3. Specify your job title or position within the company or organization where the incident occurred.
4. Describe the accident or illness in detail, including the circumstances leading up to it, what you were doing at the time, and any witnesses present.
5. If it was an accident, detail any injuries sustained and seek medical attention immediately if necessary. Note down any symptoms or issues related to the illness.
6. Indicate whether you received any first aid or medical treatment and provide relevant details, such as the name of the medical professional or facility.
7. Attach any supporting documentation, such as medical reports, photographs, or witness statements, if available.
8. Sign and date the form to certify the accuracy of the provided information.

Who needs a report of accident/illness form?

1. Employees who have been involved in a workplace accident or have experienced a work-related illness may need to fill out a report of accident/illness form.
2. Employers or HR departments may require employees to complete this form to document and investigate incidents in order to maintain a safe working environment and comply with legal regulations.
3. The form may also be used by insurance companies or workers' compensation boards to assess claims and provide appropriate coverage.

Note: It is important to consult your company's policies and procedures or seek guidance from your HR department for specific instructions on how to fill out the report of accident/illness form.

For pdfFiller’s FAQs

What is report of accident/illness form?

A report of accident/illness form is a document used to record and report any workplace accidents or illnesses that occur.

Who is required to file report of accident/illness form?

Employers are required to file a report of accident/illness form in the event of a workplace accident or illness.

How to fill out report of accident/illness form?

The report of accident/illness form should be completed with details of the incident, including date, time, location, witnesses, and a description of the accident or illness.

What is the purpose of report of accident/illness form?

The purpose of the report of accident/illness form is to document workplace incidents, investigate their causes, and take steps to prevent future accidents or illnesses.

What information must be reported on report of accident/illness form?

The report of accident/illness form should include details such as the date, time, location, description of the incident, names of witnesses, and any injuries or illnesses suffered.

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