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For Office Use (Claim No.): THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO ENVIRONMENTAL HEALTH & SAFETY DEPARTMENT PH. (210) 5672955/ FAX (210) 5672965 SUPPLEMENTAL REPORT OF INJURY
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How to fill out supplemental report of injury
How to fill out a supplemental report of injury:
01
Begin by gathering all the necessary information regarding the injury. This includes the date and time of the incident, the location, and any witnesses present.
02
Clearly identify the injured party by providing their full name, contact information, and any other relevant personal details.
03
Describe the details of the injury accurately and in detail. Include information about how it occurred, what body parts were affected, and any immediate treatment provided.
04
If applicable, provide information about the medical professional or facility that treated the injury. This includes their contact details, the date of treatment, and any relevant medical records or reports.
05
Include any additional information that may be relevant to the injury, such as the impact it has had on the injured person's ability to work or perform daily activities.
06
Sign and date the supplemental report of injury to validate its accuracy and completion.
07
Keep a copy of the report for your records and submit it to the appropriate parties, such as your employer or insurance provider.
Who needs a supplemental report of injury?
01
Employees who have experienced a work-related injury or illness may need to fill out a supplemental report of injury. This report is often required by employers to document the incident and ensure proper procedures are followed for workers' compensation claims.
02
Employers may also need a supplemental report of injury to maintain accurate records of workplace accidents and injuries. This information helps them identify and address potential hazards to improve workplace safety.
03
Insurance providers may require a supplemental report of injury to process workers' compensation claims and determine the appropriate coverage and benefits for the injured party.
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What is supplemental report of injury?
Supplemental report of injury is a form used to provide additional details about an employee's work-related injury or illness.
Who is required to file supplemental report of injury?
Employers are required to file supplemental report of injury when additional information is needed regarding an employee's work-related injury or illness.
How to fill out supplemental report of injury?
Supplemental report of injury can be filled out by providing detailed information about the injury or illness, including how it occurred and the steps taken for treatment.
What is the purpose of supplemental report of injury?
The purpose of supplemental report of injury is to ensure that all relevant information about work-related injuries or illnesses is properly documented for record-keeping and analysis.
What information must be reported on supplemental report of injury?
Information such as the date and time of the injury, the nature of the injury, any witnesses, and the treatment provided must be reported on a supplemental report of injury.
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