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OFFICE USE ONLY r Incident Only r Medical Only r Lost Time OSWEGO COUNTY REINSURANCE PLAN REPORT OF CORRELATED INJURY/ILLNESS EV (to be completed by employer or supervisor) Date of Injury/illness:

How to fill out report of work-related injuryillness

How to fill out a report of work-related injury/illness:

1. Collect all necessary information: Start by gathering all relevant details about the incident, including the date, time, and location of the event, as well as names and contact information of any witnesses. Also, make sure to document the nature and extent of the injury or illness.
2. Notify your employer: Once you have collected the required information, inform your supervisor or employer about the work-related injury or illness as soon as possible. Follow the designated reporting procedure established by your company or organization.
3. Obtain the necessary forms: Your employer should provide you with the appropriate forms to fill out. Typically, this includes an incident report form, an injury/illness report form, or a workers' compensation claim form. Request these documents if they are not automatically provided.
4. Fill out the forms accurately: Take your time to complete the forms accurately and thoroughly. Provide all requested personal information, such as your name, address, and contact details. Include a clear and concise description of the incident, explaining what happened, how it happened, and the resulting injuries or illnesses.
5. Include details of medical treatment: If you sought medical attention, include relevant details about the healthcare provider, facility, and any treatments or medications received. Attach any medical records or reports that document your injury or illness, if available.
6. Sign and date the forms: Before submitting the filled-out forms, read through them carefully and ensure that all necessary sections are completed. Sign and date each form where required. Retain a copy for your records.

Who needs a report of work-related injury/illness?

1. Employees: Any employee who suffers from a work-related injury or illness should fill out a report. It is crucial to document these incidents for both legal and medical purposes.
2. Employers: Employers must maintain records of work-related injuries and illnesses for compliance with occupational health and safety regulations. They need these reports to address safety concerns, implement preventive measures, and fulfill workers' compensation requirements.
3. Insurance companies: Insurance providers require reports of work-related injuries or illnesses to process workers' compensation claims and assess liability. These reports aid in determining compensation eligibility and evaluating the extent of injuries or illnesses.

In summary, filling out a report of work-related injury or illness involves collecting necessary information, notifying your employer, obtaining the required forms, filling them out accurately, including details of medical treatment, and signing and dating the forms. This report is essential for employees, employers, and insurance companies to address legal, medical, and insurance-related aspects.

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What is report of work-related injury/illness?

The report of work-related injury/illness is a document that outlines details of any injuries or illnesses that occur in the workplace.

Who is required to file report of work-related injury/illness?

Employers are typically required to file a report of work-related injury/illness with the appropriate government agency.

How to fill out report of work-related injury/illness?

The report of work-related injury/illness can usually be filled out online or through a physical form provided by the government agency.

What is the purpose of report of work-related injury/illness?

The purpose of the report is to document and track workplace injuries and illnesses for statistical and regulatory purposes.

What information must be reported on report of work-related injury/illness?

Information that must be reported typically includes details about the injured/ill employee, the nature of the injury/illness, and when and where it occurred.