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Form 659A EMPLOYEE S REPORT OF ACCIDENT/INJURY Rev. Jan. 10 2007 AFTER FORM IS FULLY COMPLETED, IMMEDIATELY FAX TO (416) 393-8533. INJURED WORKER (Report this injury or accident to your Principal/Team

How to fill out employee39s report of accidentinjury

How to fill out an employee's report of accident/injury:

1. Provide basic information: Start by filling out the necessary personal details such as the employee's name, contact information, job title, and department.
2. Describe the accident: Explain the specific details of the accident or injury. Include the date, time, and location of the incident. Provide a clear description of what happened, how it happened, and any factors that contributed to the accident.
3. Identify witnesses: If there were any witnesses present during the accident, record their names and contact information. Their statements may be valuable in supporting the employee's report.
4. Document injuries or damages: Record the extent of the employee's injuries or damages sustained during the accident. Specify the body part affected, the severity of the injury, and any immediate medical attention received.
5. Outline the cause: Identify the potential causes or contributing factors leading to the accident. This could include equipment malfunctions, environmental hazards, or human error.
6. Include supporting documentation: If possible, attach any relevant documents or evidence related to the accident. This may include photographs, medical reports, incident reports, or any other supporting materials.
7. Provide additional information: If there are any other relevant details about the accident or injury that should be mentioned, include them in this section.
8. Sign and date the report: The employee should sign and date the report to confirm its accuracy and validity.
9. Submit the report: The completed report should be submitted to the appropriate department or person in the organization responsible for handling such incidents.

Who needs an employee's report of accident/injury?

1. Employers: Employers need the employee's report of accident/injury to understand the nature of the incident and take appropriate actions. It helps them investigate the circumstances, make improvements to prevent future accidents, and assess potential liability.
2. Human Resources: The HR department typically handles the documentation and filing of employee reports of accident/injury to maintain records for legal, logistical, and safety purposes. They may also need the report to initiate workers' compensation processes or insurance claims.
3. Insurance providers: Insurance companies may require the employee's report of accident/injury to process any claims filed for medical expenses, lost wages, or rehabilitation. It helps them assess the legitimacy of the claim and provide appropriate coverage.
4. Legal entities: In case of legal disputes or investigations, attorneys or legal entities may request the employee's report of accident/injury as evidence or as part of the legal proceedings.
5. Occupational Health and Safety Authorities: Occupational health and safety authorities may require the report to monitor workplace safety standards, investigate potential violations, and ensure compliance with regulations.
6. Employee: The employee creating the report may need a copy for their personal records, reference, or to support their claims for compensation or disability benefits.

For pdfFiller’s FAQs

What is employee's report of accident/injury?

Employee's report of accident/injury is a documentation of any work-related accident or injury that an employee experienced while on the job.

Who is required to file employee's report of accident/injury?

The employee who experienced the accident or injury is required to file the report.

How to fill out employee's report of accident/injury?

The employee should provide details of the accident or injury, including date, time, location, witnesses, and any treatment received.

What is the purpose of employee's report of accident/injury?

The purpose of the report is to document the incident, ensure proper treatment is provided, and prevent similar accidents in the future.

What information must be reported on employee's report of accident/injury?

The report should include details of the accident/injury, date and time, location, witnesses, and any treatment received.

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