Get Employee Report Of Injury Form - City Of Ypsilanti

This guide provides step-by-step instructions for completing the Employee Report Of Injury Form for City Of Ypsilanti online. It is essential for employees to accurately report work-related injuries, illnesses, or near misses to ensure proper documentation and follow-up.

Follow the steps to complete the form online:

1. Click ‘Get Form’ button to obtain the form and open it in your online editor.
2. Begin by indicating the nature of the report by selecting Injury, Illness, or Near Miss.
3. Fill in your full name, job title, date of birth, telephone number, and home address including city, state, and zip code.
4. Indicate your gender by selecting either Male or Female.
5. Confirm whether you have informed your supervisor about the incident by selecting Yes or No.
6. Provide the date and time of the injury or near miss.
7. List any witnesses to the incident, if applicable.
8. Describe the exact location where the incident occurred.
9. Explain what you were doing at the time of the incident.
10. Detail the events that led up to the injury or near miss, using clear and concise language.
11. Suggest ways that the injury or near miss could have been prevented.
12. Identify which parts of your body were affected or how you could have been hurt in a near miss situation.
13. Indicate whether you saw a doctor for the injury or illness, and if so, provide the doctor's name and phone number.
14. Complete the section regarding any previous injuries to the same part of the body.
15. Provide your supervisor’s name and sign the form, including the date.
16. After completing the form, save any changes made, download a copy, print it if needed, and share it as required.

Ensure your safety and workplace compliance by completing the Employee Report Of Injury Form online.