Get the free Report of Injury Form REVISED15.doc

REPORT OF INJURY ONTHEJOB JOHNSTON COUNTY This report is to be filled out by the employee for each accident/injury and returned to the Supervisor to be forwarded to the Risk Management Coordinator

How to fill out report of injury form

1. The first step in filling out a report of injury form is to carefully read through the entire form. This will help you understand the information that is needed and the specific instructions provided.
2. Begin by providing your personal details, including your full name, contact information, and job title. This will help identify you as the person involved in the incident.
3. Next, provide a detailed description of the injury or incident. Include important information such as the date, time, and location of the incident. Describe what happened, how it happened, and any contributing factors.
4. Make sure to include information about any witnesses present during the incident. Provide their names, contact details, and a brief statement of what they witnessed. This can be crucial for further investigation or verification of your account.
5. If applicable, provide information about any medical treatment or first aid administered after the incident. Include details of the healthcare professionals involved, the facility where the treatment took place, and any medications or procedures conducted.
6. You may be asked to provide information about any equipment or tools involved in the incident. Include their descriptions, serial numbers, and any other relevant details that could help in identifying the cause of the injury.
7. Finally, sign and date the report of injury form to certify the accuracy of the information provided. Make sure to keep a copy of the completed form for your records.

Who needs a report of injury form?

1. Employees who have been injured on the job need a report of injury form. It is crucial to report any workplace injuries promptly to ensure proper documentation and access to necessary benefits or compensation.
2. Employers also need a report of injury form to comply with legal requirements and establish a record of workplace incidents. It helps them identify potential hazards, improve safety procedures, and determine appropriate measures to prevent future incidents.
3. Insurance providers may require a report of injury form to process a claim for workers' compensation benefits. This document serves as evidence of the injury and the circumstances surrounding it.

Remember, it is essential to consult with your employer or follow your organization's specific procedures for reporting injuries. This will ensure that the report of injury form is completed accurately and submitted to the appropriate parties in a timely manner.

For pdfFiller’s FAQs

Where do I find report of injury form?

It's simple using pdfFiller, an online document management tool. Use our huge online form collection (over 25M fillable forms) to quickly discover the report of injury form. Open it immediately and start altering it with sophisticated capabilities.

How do I make edits in report of injury form without leaving Chrome?

Install the pdfFiller Google Chrome Extension to edit report of injury form and other documents straight from Google search results. When reading documents in Chrome, you may edit them. Create fillable PDFs and update existing PDFs using pdfFiller.

Can I edit report of injury form on an Android device?

You can make any changes to PDF files, such as report of injury form, with the help of the pdfFiller mobile app for Android. Edit, sign, and send documents right from your mobile device. Install the app and streamline your document management wherever you are.

What is report of injury form?

The report of injury form is a documentation that details an injury that occurred in the workplace.

Who is required to file report of injury form?

Employers are required to file the report of injury form when an employee is injured while on the job.

How to fill out report of injury form?

The report of injury form can be filled out by providing all necessary details about the incident, including date, time, location, and description of the injury.

What is the purpose of report of injury form?

The purpose of the report of injury form is to accurately document workplace injuries and ensure that necessary steps are taken for proper medical treatment and prevention of future incidents.

What information must be reported on report of injury form?

Information such as date of injury, time of injury, location of injury, description of injury, and witness information must be reported on the report of injury form.