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State of Maryland Department of Health and Mental Hygiene BEHAVIORAL HEALTH ADMINISTRATION Catonsville, MD 21228NOTIFICATION OF SERIOUS INJURY (NOT RELATED TO RESTRAINT/SECLUSION) OR SUICIDE ATTEMPT
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How to fill out notification of serious injury

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How to fill out notification of serious injury

01
Step 1: Gather all relevant information about the serious injury, such as the date, time, and location it occurred.
02
Step 2: Fill out the injured person's personal details, including their name, contact information, and employment status.
03
Step 3: Provide a detailed description of the injury, including the body parts affected and the severity of the injury.
04
Step 4: Include any witness information, if applicable, along with their contact details.
05
Step 5: Provide information about the medical treatment received by the injured person, including the names of medical practitioners and any hospitalization details.
06
Step 6: Sign and date the notification form to certify the accuracy of the information provided.
07
Step 7: Submit the completed notification of serious injury to the appropriate authority or organization.

Who needs notification of serious injury?

01
Employers or supervisors who are responsible for reporting serious injuries to the relevant authorities.
02
Employees who have suffered a serious injury and need to notify their employer or seek compensation.

What is NOTIFICATION OF SERIOUS INJURY (NOT RELATED TO RESTRAINT/SECLUSION) OR SUICIDE ATTEMPT FOR A MINOR IN A RESIDENTIAL TREATMENT CENTER Form?

The NOTIFICATION OF SERIOUS INJURY (NOT RELATED TO RESTRAINT/SECLUSION) OR SUICIDE ATTEMPT FOR A MINOR IN A RESIDENTIAL TREATMENT CENTER is a fillable form in MS Word extension that should be submitted to the specific address to provide some info. It needs to be filled-out and signed, which may be done in hard copy, or by using a particular software e. g. PDFfiller. It allows to fill out any PDF or Word document directly from your browser (no software requred), customize it depending on your purposes and put a legally-binding e-signature. Right after completion, user can easily send the NOTIFICATION OF SERIOUS INJURY (NOT RELATED TO RESTRAINT/SECLUSION) OR SUICIDE ATTEMPT FOR A MINOR IN A RESIDENTIAL TREATMENT CENTER to the appropriate receiver, or multiple recipients via email or fax. The editable template is printable too because of PDFfiller feature and options proposed for printing out adjustment. Both in digital and physical appearance, your form will have a organized and professional look. You can also save it as the template for later, without creating a new document again. Just edit the ready template.

Template NOTIFICATION OF SERIOUS INJURY (NOT RELATED TO RESTRAINT/SECLUSION) OR SUICIDE ATTEMPT FOR A MINOR IN A RESIDENTIAL TREATMENT CENTER instructions

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A notification of serious injury is a formal report that must be filed when an employee suffers a serious injury at the workplace, as required by occupational safety regulations.
The employer or a designated representative is typically required to file the notification of serious injury.
To fill out the notification of serious injury, the employer must complete the appropriate form with details about the injury, including the nature of the injury, date and time, and circumstances surrounding the incident.
The purpose of the notification of serious injury is to inform regulatory authorities about workplace incidents that pose a risk to employee health and safety, enabling them to investigate and ensure compliance.
The notification must include information such as the employee's name, age, job title, the nature of the injury, date and time of the incident, location, and any witnesses.
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