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University Students Council of the University of Western Ontario INJURY/ILLNESS REPORTING FORM FOR PERSON REPORTING THE INJURY/ILLNESS Name of ill or injured person: ....................................................
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How to fill out injuryillness reporting form
How to fill out an injury/illness reporting form:
01
Begin by providing your personal information such as your name, contact number, and address. This information will be essential for further communication regarding the incident.
02
Indicate the date and time of the injury or illness. Be as accurate as possible to aid in the investigation process.
03
Describe the nature of the injury or illness in detail. Include specific information such as the location, symptoms, and any factors that may have contributed to the incident.
04
If applicable, include the names and contact details of any witnesses who may have observed the incident.
05
Indicate whether you sought medical treatment for your injury or illness. If you did, provide details such as the healthcare professional you visited, the date and time of the appointment, and any medication or treatment prescribed.
06
If the incident occurred in the workplace, provide your job title, department, and supervisor's name. This information will help determine any potential risks or hazards in the work environment.
07
Finally, sign and date the form to acknowledge that the information provided is accurate and complete.
Who needs an injury/illness reporting form:
01
Employers: Employers are typically required by law to maintain a record of workplace injuries and illnesses. This form helps employers comply with these regulations and ensure a safe work environment for their employees.
02
Employees: If an employee sustains an injury or develops an illness related to their work, they may need to fill out an injury/illness reporting form. This allows them to document the incident and provide details for any necessary insurance claims or legal matters.
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What is injury/illness reporting form?
The injury/illness reporting form is a document used to report any work-related injuries or illnesses that occur in the workplace.
Who is required to file injury/illness reporting form?
Employers are required to file the injury/illness reporting form in order to comply with occupational health and safety regulations.
How to fill out injury/illness reporting form?
The injury/illness reporting form should be filled out with details of the incident, including date, time, location, description of the injury/illness, and any contributing factors.
What is the purpose of injury/illness reporting form?
The purpose of the injury/illness reporting form is to track and analyze work-related injuries and illnesses in order to improve workplace safety and prevent future incidents.
What information must be reported on injury/illness reporting form?
Information such as the date, time, location, nature of injury/illness, name of the injured/ill employee, contributing factors, and any treatment provided must be reported on the injury/illness reporting form.
Where do I find injuryillness reporting form?
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