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CITY OF JACKSON Record of Training OnTheJob InjuryEmployee Name: Employee #: Dept. Name: Supervisor/Dept. Head: Employee Address: Employee Phone#I, HAVE BEEN INFORMED BY THE CITY OF JACKSON OF THE

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How to fill out 5013 reporting on-form-job injury

01

Obtain the 5013 reporting on-form-job injury from your employer.

02

Fill out the personal information section, including your name, date of birth, address, and social security number.

03

Provide details about the injury, including the date and time it occurred, the location, and a description of what happened.

04

Indicate whether you sought medical treatment for the injury and provide details about the healthcare provider.

05

Provide information about any witnesses to the injury, including their names and contact information.

06

Sign and date the form to certify the accuracy of the information provided.

07

Submit the completed form to your employer or the appropriate designated party as instructed.

Who needs 5013 reporting on-form-job injury?

01

Any employee who experienced a job-related injury and wants to report it should fill out the 5013 reporting on-form-job injury.

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What is 5013 reporting on-form-job injury?

5013 reporting on-form-job injury is a form used to report any on-the-job injuries that occur while at work.

Who is required to file 5013 reporting on-form-job injury?

Employers are required to file 5013 reporting on-form-job injury for any employee who sustains an injury while on the job.

How to fill out 5013 reporting on-form-job injury?

To fill out 5013 reporting on-form-job injury, you must provide details about the injury, including when and where it occurred, the nature of the injury, and any treatment received.

What is the purpose of 5013 reporting on-form-job injury?

The purpose of 5013 reporting on-form-job injury is to document workplace injuries and ensure that employees receive the necessary medical treatment and benefits.

What information must be reported on 5013 reporting on-form-job injury?

Information that must be reported on 5013 reporting on-form-job injury includes the employee's name, date of injury, description of the injury, and any medical treatment provided.

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