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This agency instruction establishes the policy for enforcing the reporting of known or suspected occupational diseases in Michigan as per the Michigan Public Health Code.
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How to fill out miosha-com-12-1r3
How to fill out miosha-com-12-1r3
01
Obtain the MIOSHA COM-12 (1R3) form from the Michigan Occupational Safety and Health Administration website or your local MIOSHA office.
02
Fill in the employer's name, address, and phone number at the top of the form.
03
Provide the name of the contact person and their title.
04
Enter the date of the incident in the appropriate field.
05
Describe the nature of the incident in detail, including what occurred, where it happened, and any immediate actions taken.
06
Complete the section detailing the employee(s) involved, including their name, job title, and any relevant injury details.
07
Check the boxes that apply regarding the industry and type of incident.
08
Fill in the corrective actions that were taken or will be taken to prevent recurrence of the incident.
09
Include any additional supporting documentation or details in an attached sheet if necessary.
10
Sign and date the form before submission.
Who needs miosha-com-12-1r3?
01
Employers in Michigan who are required to report workplace incidents, injuries, or illnesses as per MIOSHA regulations.
02
Safety personnel responsible for maintaining compliance with occupational safety standards.
03
Any organization seeking to improve workplace safety management and incident reporting protocols.
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What is miosha-com-12-1r3?
MIOSHA-com-12-1r3 is a form used by employers in Michigan to report occupational injuries and illnesses to the Michigan Occupational Safety and Health Administration (MIOSHA).
Who is required to file miosha-com-12-1r3?
All employers in Michigan who have 11 or more employees and are subject to MIOSHA regulations are required to file the MIOSHA-com-12-1r3 form.
How to fill out miosha-com-12-1r3?
To fill out MIOSHA-com-12-1r3, employers should provide information about the employee, the nature of the injury or illness, the circumstances surrounding the incident, and any medical treatment required.
What is the purpose of miosha-com-12-1r3?
The purpose of MIOSHA-com-12-1r3 is to collect data on workplace injuries and illnesses, which is used to improve safety regulations and practices in Michigan.
What information must be reported on miosha-com-12-1r3?
The information that must be reported on MIOSHA-com-12-1r3 includes employee details, description of the injury or illness, date of the incident, and the location where the incident occurred.
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