Get the free Illness or Injury Report Form - workconnections umich

This form is utilized for reporting both work-related and non-work-related illnesses or injuries among employees at the University of Michigan, ensuring compliance with state law regarding medical

How to fill out illness or injury report

How to fill out Illness or Injury Report Form

1. Obtain the Illness or Injury Report Form from the designated authority or website.
2. Read the instructions on the form carefully before filling it out.
3. Provide personal details such as name, date of birth, and employee ID if applicable.
4. Describe the nature of the illness or injury clearly and accurately.
5. Include the date and time when the illness or injury occurred.
6. Mention any witnesses if applicable, including their contact information.
7. Sign and date the form before submission.
8. Submit the completed form to the appropriate department or personnel.

Who needs Illness or Injury Report Form?

1. Employees who have suffered an illness or injury at work.
2. Supervisors or managers who need to document incidents for record-keeping.
3. Human resources personnel for processing claims or investigations.
4. Insurance companies if related to worker's compensation claims.

People Also Ask about

Which 3 forms are used to record injuries and illnesses?

Establishments that meet certain size and industry criteria are required to electronically submit injury and illness data from their OSHA Form 300A, 300, and 301 (or equivalent forms) once per year to OSHA. OSHA collects this work-related injury and illness data through the Injury Tracking Application (ITA).

Is OSHA 301 form called the injury and illness incident report?

Occupational Safety and Health Administration (OSHA) Form 301, “Injury and Illness Incident Report,” is used by employers to keep a record of a single injury, illness, or death in a workplace. This form is found within OSHA Form 300, which is used to log and classify all such incidents for a workplace.

What are the 3 classifications of OSHA recordable injuries?

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 injury and illness incident report?

Injury and Illness reporting is the reporting of workplace incidents that result in harm to an employee. It is often called incident reporting, though that is a broad term that can also include a range of incidents like vehicle accidents and chemical spills.

What are the three forms of OSHA?

You must 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. Be sure to transfer these totals to the Summary page (Form 300A) before you post it.

For pdfFiller’s FAQs

What is Illness or Injury Report Form?

An Illness or Injury Report Form is a document used to officially record details about an injury or illness that occurs in the workplace or during an activity, capturing the circumstances of the incident, the affected parties, and any necessary follow-up actions.

Who is required to file Illness or Injury Report Form?

Typically, any employee who experiences an illness or injury during work hours or in connection with their job responsibilities is required to file an Illness or Injury Report Form. Additionally, supervisors or managers may need to complete the form if they observe an incident.

How to fill out Illness or Injury Report Form?

To fill out the Illness or Injury Report Form, one must provide essential information including the date and time of the incident, a detailed description of what occurred, the names of those involved, and any witnesses, as well as a summary of any medical treatment received.

What is the purpose of Illness or Injury Report Form?

The purpose of the Illness or Injury Report Form is to document workplace incidents for record-keeping, compliance with health and safety regulations, providing necessary information for workers' compensation claims, and improving workplace safety by identifying hazards.

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

The information that must be reported includes the date and time of the incident, location, description of the illness or injury, details of the circumstances surrounding the incident, identification of any witnesses, and steps taken for medical treatment or follow-up.