Get 55b23

Filling out the 55b23 form is a critical process for employers to document workplace injuries and illnesses accurately. This guide provides clear, step-by-step instructions to help you complete the form effectively.

Follow the steps to successfully complete the 55b23 form.

1. Click the ‘Get Form’ button to access the 55b23 document and open it in your preferred online editor.
2. Enter the sequence number in the designated field at the top of the form.
3. In the 'Name' field, provide the full name of the individual who experienced the injury or illness.
4. Fill in the occupation of the person involved in the incident to clarify their job title.
5. Record the date of the injury or illness using the format yyyy-mm-dd for consistency.
6. Indicate the time of the injury or illness, choosing either a.m. or p.m. for accuracy.
7. Document the initial reporting date and time using the yyyy-mm-dd format, along with a.m. or p.m.
8. If applicable, enter the date and time of the follow-up report, including the correct time notation.
9. Detail the initial report sequence number and subsequent report sequence number(s) as necessary.
10. Provide a thorough description of how the injury, exposure, or illness occurred, explaining what happened.
11. Document the nature of the injury, exposure, or illness, including any visible signs and symptoms.
12. Describe the treatment that was administered by outlining the actions taken.
13. List the names of any witnesses present during the incident in the provided fields.
14. Indicate the arrangements made concerning the worker, such as return to work or medical aid options.
15. Confirm whether a worker handout was provided and if alternate duty options were discussed.
16. Print the first aid attendant's name clearly in the designated area.
17. Complete the first aid attendant's signature field to verify the report.
18. Have the patient sign the form to acknowledge the information provided.
19. After filling out all required fields, save your changes, download the document, print it, or share it as needed.

Start completing the 55b23 form online today!