Get the free Notice of Injury/Illness and Investigation Form

This form is used to report workplace injuries or illnesses, including details about the incident, the nature of injuries, and witness information.

How to fill out notice of injuryillness and

How to fill out Notice of Injury/Illness and Investigation Form

1. Start by entering the date of the incident at the top of the form.
2. Fill in the employee's personal information, including name, job title, and department.
3. Provide details about the incident, specifying the time and location where it occurred.
4. Describe the nature of the injury or illness sustained by the employee.
5. Include a section for witnesses if applicable, providing their names and contact information.
6. Document any immediate actions taken in response to the incident, such as first aid administered.
7. Sign and date the form to certify that the information provided is accurate.
8. Submit the completed form to the appropriate supervisor or HR representative.

Who needs Notice of Injury/Illness and Investigation Form?

1. All employees who sustain an injury or illness while performing work-related duties.
2. Supervisors and managers who are responsible for workplace safety and incident reporting.
3. Human Resources personnel for compliance and record-keeping purposes.

For pdfFiller’s FAQs

What is Notice of Injury/Illness and Investigation Form?

The Notice of Injury/Illness and Investigation Form is a document used to report and investigate incidents of injury or illness in the workplace. It helps ensure that proper procedures are followed for safety and compliance.

Who is required to file Notice of Injury/Illness and Investigation Form?

Typically, employers are required to file the Notice of Injury/Illness and Investigation Form for any employee who experiences a work-related injury or illness.

How to fill out Notice of Injury/Illness and Investigation Form?

To fill out the Notice of Injury/Illness and Investigation Form, provide details such as the date and time of incident, description of the injury/illness, affected employee's name, witnesses, and any immediate actions taken.

What is the purpose of Notice of Injury/Illness and Investigation Form?

The purpose of the Notice of Injury/Illness and Investigation Form is to document the incident for legal and insurance purposes, to initiate investigations, and to implement preventive measures to avoid future occurrences.

What information must be reported on Notice of Injury/Illness and Investigation Form?

Required information includes the date and time of the incident, location, names of individuals involved, description of the injury or illness, witness statements, and any corrective actions taken.