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UNIVERSITY OF WASHINGTON, BOTHELL POLICIES AND PROCEDURES MANUAL Overview Policy Procedure Injuries, Illnesses, and Near Misreporting ACCIDENTS/INCIDENTS/NEAR MISSES 11.3 REV 03/05 Administrative
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To fill out injuries illnesses form, follow these steps:
02
Obtain the injuries illnesses form from your employer or insurance company.
03
Read the instructions provided with the form carefully to understand the required information.
04
Start by entering your personal details, such as your name, address, and contact information.
05
Specify the date and time of the injury or illness.
06
Provide a detailed description of the injury or illness, including the body part affected and the circumstances surrounding it.
07
If applicable, provide information about any medical treatment you received or plan to receive.
08
If there were any witnesses to the incident, include their names and contact information.
09
Review the completed form for accuracy and completeness.
10
Sign and date the form to certify the information provided.
11
Submit the form to your employer or insurance company as instructed.

Who needs injuries illnesses and?

01
Injuries illnesses form is required by individuals who have suffered an injury or illness in the workplace or in relation to their employment.
02
This form is used to report and document the details of the incident, which may be necessary for insurance purposes, workers' compensation claims, or legal purposes.
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Employers may also require their employees to fill out this form to maintain a record of workplace injuries and illnesses for compliance and safety purposes.
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