Get the free Injury Report Supplement - publicsafety syr

SYRACUSE UNIVERSITY Page 3 Department of Public Safety Injury Report Additional Persons Attachment NAME

How to fill out injury report supplement

How to Fill Out an Injury Report Supplement:

1. Start by obtaining a copy of the injury report supplement form. This form can usually be obtained from your employer, supervisor, or HR department. Make sure you have the most up-to-date version of the form.
2. Begin by providing your personal information. This may include your name, address, contact information, and employee identification number.
3. Clearly state the date and time of the incident that resulted in the injury. Be as specific as possible to accurately document when the incident occurred.
4. Provide a detailed description of the injury. Include information such as the type of injury, the body part affected, and any immediate medical treatment received.
5. If applicable, mention any witnesses who were present during the incident. Include their names and contact information, as their statements may be needed for further investigation.
6. Describe the circumstances surrounding the injury. Explain what actions led to the incident and any contributing factors that may have played a role.
7. If there were any equipment or machinery involved, provide the necessary details. Include the equipment's name, model number, and any relevant identification numbers.
8. Indicate whether any safety precautions were in place at the time of the incident. This could include safety gear, warning signs, or any training you had received.
9. If you sought medical attention following the injury, provide the name and contact information of the healthcare provider or facility you visited. Include any diagnoses, treatments, or prescriptions received.
10. Sign and date the form to certify the accuracy of the information provided. Keep a copy of the completed report for your records.

Who Needs an Injury Report Supplement?

The injury report supplement is typically necessary when an employee has been involved in a worksite incident that resulted in injury. This requirement is imposed by most employers as a means of accurately documenting workplace injuries or accidents. Anyone who experiences an injury while on the job, regardless of the severity, should complete an injury report supplement to ensure that the incident is officially recorded and appropriate actions can be taken to prevent similar incidents in the future. It is important to consult your employer's policies or procedures to determine if you need to fill out an injury report supplement in your specific workplace.

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What is injury report supplement?

The injury report supplement is a document used to provide additional information about an injury that was listed on the original injury report.

Who is required to file injury report supplement?

The person responsible for completing the original injury report is typically required to file the injury report supplement.

How to fill out injury report supplement?

To fill out the injury report supplement, you will need to provide detailed information about the injury, including any new developments or changes in the individual's condition.

What is the purpose of injury report supplement?

The purpose of the injury report supplement is to ensure that all relevant information about an injury is documented and communicated effectively.

What information must be reported on injury report supplement?

The injury report supplement should include any new information about the injury, changes in the individual's condition, and updates on the treatment plan.