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YS FROM NOTICE OF ACCIDENT. FATALITIES MUST BE REPORTED TO OSHA WITHIN 8 HOURS AND TO THE ICA WITHIN 24 HOURS. OSHA Case No. FOR CARRIER USE ONLY Doc Type: IR101 Recordable Injury Non-Recordable Injury MAIL COPY TO: COPPERPOINT INSURANCE COMPANIES Please check appropriate company q CopperPoint Mutual Insurance Company q CopperPoint American Insurance Company q CopperPoint Casualty Insurance Company q CopperPoint General Insurance Company 3030 N. 3rd Street Phoenix, AZ 85012 Phone: 1.800.231.

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