Get Employee Accident/violent Incident Report Form 421-1 - Hpedsb On

Filling out the EMPLOYEE ACCIDENT/VIOLENT INCIDENT REPORT FORM 421-1 is an essential step in documenting any workplace incidents. This guide will provide you with detailed, step-by-step instructions to help ensure that the form is completed accurately and submitted promptly.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your editing tool.
2. Once the form is open, begin by checking the appropriate box to indicate whether the report is for an accident or a violent incident.
3. Fill out the EMPLOYEE INFORMATION section, entering your name, home phone number, work location, date of birth, job title, and working hours.
4. Provide details regarding the accident or violent incident in the corresponding sections. Include necessary dates, specifics on how and under what circumstances the incident occurred, and select any applicable options (e.g., types of incidents or injuries).
5. If there is an injury, complete the appropriate areas regarding the location and side (left or right) of the injury.
6. Document any witnesses to the incident and provide details of individuals who may have been responsible, if applicable.
7. Address any health care received related to the incident, including where treatment was sought and whether prescriptions were made.
8. Choose the appropriate option regarding lost time or return to work after the incident, and indicate any involvement of other organizations as necessary.
9. Review all entered information for accuracy. Once you are satisfied with the details, sign and date the report.
10. After completion, submit the form to your Principal/Supervisor and ensure they sign off before sending it to Human Resources Support Services within the required timeframe.
11. Finally, save your changes, download or print the completed form for your records, and ensure it is emailed or faxed as directed to Human Resources.

Complete the EMPLOYEE ACCIDENT/VIOLENT INCIDENT REPORT FORM 421-1 online today for a smoother reporting process.