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City of Miami Public Works Operations Employees OnlySUPERVISORS REPORT OF EMPLOYEE ACCIDENT/INJURY Instructions: This form must be completed by the supervisor and the claims network must be contacted
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Obtain a copy of the 17 printable workplace accident form.
02
Fill out the employee's personal information, such as name, contact information, and job title.
03
Provide details of the accident, including the date, time, and location.
04
Describe the circumstances of the accident and what injuries occurred.
05
Include any witnesses to the accident and their contact information, if available.
06
Sign and date the form to certify the accuracy of the information provided.

Who needs 17 printable workplace accident?

01
Employers who are required by law to report workplace accidents
02
Employees who have been involved in a workplace accident
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17 printable workplace accident refers to a form or document used to report workplace accidents or injuries.
Employers or the responsible party at the workplace are required to file 17 printable workplace accident.
To fill out 17 printable workplace accident, you must provide details about the accident or injury, including date, time, location, description, and any witnesses.
The purpose of 17 printable workplace accident is to document and report workplace accidents or injuries for legal and safety reasons.
Information such as date, time, location, description of the accident, names of individuals involved, and any treatment provided must be reported on 17 printable workplace accident.
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