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ARN#Cleveland State UniversityInjury/Occupational Illness Report (Applicable for Employees, Students, and Visitors) Instructions for Report completion: Complete the form in its entirety within 24
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How to fill out injuryoccupational illness report

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How to fill out injuryoccupational illness report

01
Gather all necessary information about the injury or occupational illness, including the date, time, and location of the incident.
02
Begin by providing the personal details of the injured person, such as their name, address, and contact information.
03
Describe the nature of the injury or illness in detail, including the body parts affected and any possible causes or contributing factors.
04
If there were witnesses present during the incident, make sure to include their names and contact information as well.
05
Include any medical treatment received, including the names of healthcare providers and facilities involved.
06
Provide a detailed timeline of events leading up to and following the injury or illness.
07
If applicable, provide information about any previous injuries or illnesses related to the current incident.
08
Sign and date the report to certify its accuracy and completeness.

Who needs injuryoccupational illness report?

01
Any individual who has experienced an injury or occupational illness and wishes to report it should fill out an injury/occupational illness report.
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An injury occupational illness report is a formal document used to record details about workplace injuries or illnesses experienced by employees.
Employers, typically those with a certain number of employees or those in specific industries, are required to file an injury occupational illness report.
To fill out an injury occupational illness report, include details such as employee information, incident description, date and time of the injury, and any medical treatment received.
The purpose of the injury occupational illness report is to document work-related injuries and illnesses for compliance, safety analysis, and to facilitate claims processing.
Information that must be reported includes the employee's personal details, the nature of the injury or illness, the cause, date and time of occurrence, and any witnesses.
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