Get Employee S Injury And/or Illness Report Form Pi-1a

Completing the employee's injury and/or illness report form PI-1A online is an essential step in ensuring that workplace incidents are properly documented and addressed. This guide provides clear, step-by-step instructions to assist users in filling out the form accurately and efficiently.

Follow the steps to effectively complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your editor of choice.
2. Begin by entering the employee name in the designated field, followed by the employee ID number. Ensure that all entries are accurate and clearly legible.
3. Proceed to include the address of the employee, which should consist of the street address, city, state, zip code, and phone number. This provides essential contact information.
4. Fill in the date of birth, age, occupation, and department of the employee in the corresponding fields. Accurate details here are important for identification.
5. Record the date hired, number of consecutive days worked, and the number of hours off prior to the tour of duty. These fields are crucial for understanding the work history leading up to the incident.
6. Indicate the incident location, including details such as shop, plant, or specific area of occurrence. Additionally, provide the city, county, and state of the incident.
7. Fill out the date and time of the incident, including whether it was AM or PM, and provide information on the weather and visibility conditions at the time of the event.
8. Answer whether medical attention was provided and, if so, include the name and address of the physician and medical facility. Describe any medical or first-aid treatment received, noting if prescription medication was included.
9. Describe the incident thoroughly in the designated field. Clarify if this was a recurrence of a previous incident and whether it will result in lost workdays.
10. Answer questions regarding any faults, defective tools or equipment, and the safety conditions at the workplace. Be honest and provide details if any safety hazards were present.
11. Document witness names and addresses, if applicable, to corroborate the account of the incident. The employee and any witnesses must sign and date the form before submission.
12. Review the entire form for accuracy and completeness before finalizing. Once completed, options to save changes, download, print, or share the form should be available.

Complete your employee's injury and/or illness report form online today to ensure proper documentation and follow-up.