Get Pdf Fillable Basic Incident Report Tennessee Form

Completing the Pdf Fillable Basic Incident Report Tennessee Form is an essential step when a work-related injury or illness occurs. This guide provides clear instructions on how to properly fill out the form online.

Follow the steps to complete the incident report accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the PDF editor.
2. Begin by entering the employee's name in the designated fields for first name, middle initial, and last name. Ensure all names are spelled correctly to avoid any confusion.
3. Fill in the birthdate field with the proper format and select the appropriate sex from the available options.
4. In the job title field, specify the employee's exact position held at the time of the incident.
5. Complete the home address section, including street address, city, state, and zip code, along with the home phone number.
6. Enter the supervisor's name and the full state agency name, beginning with 'ETSU- ' followed by the department name.
7. Provide the office address, including the box number and city, ensuring all details are accurate.
8. Document the exact location of the project where the injury occurred and indicate the county.
9. Answer the questions about whether the employee's duties required being at the location of the injury and if they left work on the day of the incident.
10. Detail the date of the accident, specifically describing the injury and how it occurred in the description fields.
11. Fill out additional fields regarding the length of probable disability, time lost from work, details of any physician visits, and hospitalization status.
12. Once all fields are completed, carefully review the information for accuracy. Utilize the save function to keep your changes.
13. You can then download the completed form, print it out, and ensure it is signed before submission to Human Resources.

Start filling out your forms online today for a smooth incident reporting process.