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DNRHR6 1/20/2016-Page 1 of 2 pages DEPARTMENT OF NATURAL RESOURCES WORK RELATED INJURY/ILLNESS REPORT FORM (Use this form to document a work related injury or illness.) Injured employee: Last Name
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How to fill out work related injuryillness report

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How to fill out work related injuryillness report

01
Gather all necessary information about the work-related injury or illness.
02
Start by filling out the employee's personal information, such as name, contact details, and job title.
03
Provide a detailed description of the injury or illness, including the date, time, and location of the incident.
04
Specify the nature of the injury or illness and provide any relevant medical diagnosis or treatment received.
05
Include information about any witnesses present at the time of the incident.
06
Document any safety hazards or equipment failures that may have contributed to the injury or illness.
07
Submit the completed form to the appropriate department or supervisor for review and further action.
08
Keep a copy of the report for your records.

Who needs work related injuryillness report?

01
Employees who have experienced a work-related injury or illness need to fill out a work-related injury/illness report.
02
Employers and supervisors also require the report to investigate the incident, ensure proper medical treatment is provided, and implement preventive measures to avoid similar incidents in the future.
03
Insurance companies may request a copy of the report for claim processing purposes.
04
Government agencies responsible for occupational health and safety may require work-related injury/illness reports for regulatory compliance and statistical analysis.
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Work related injury/illness report is a document used to record and report any work-related injuries or illnesses that occur in the workplace.
Employers are required to file work related injury/illness reports for any incidents that result in injuries or illnesses to their employees.
Work related injury/illness reports should be filled out with details of the incident, the injured or ill employee, and any medical treatment provided.
The purpose of work related injury/illness report is to document and track work-related incidents, ensure proper treatment for affected employees, and prevent future incidents.
Work related injury/illness reports must include details of the incident, the affected employee, any medical treatment provided, and steps taken to prevent future incidents.
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