Get Employers Worksheet For Reporting Serious Injuries Form

Filling out the Employers Worksheet For Reporting Serious Injuries Form online is an essential task for employers to ensure compliance with Cal/OSHA regulations. This guide will provide you with step-by-step instructions to complete the form accurately and efficiently.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Enter the date of the incident in the specified format (Month/Day/Year).
3. Indicate the time of the incident by selecting AM or PM.
4. Provide the address or site where the incident occurred in the designated field.
5. Fill in the name, address, and phone number of the injured employee.
6. If available, include an alternate phone number for the employee.
7. Document the location where the injured employee was moved, including the address and phone number.
8. Specify the nature of the injury (e.g., amputation, puncture wound) clearly in the provided section.
9. Describe the incident in detail, including any alterations to the scene or equipment involved.
10. List any law enforcement agencies present at the scene of the incident.
11. Enter the employer's information, including the employer's name, phone number, and address.
12. Provide the name and title or badge number of the person reporting the incident.
13. Include the name of the employer representative to contact at the site of the incident.
14. Use the Cal/OSHA reporting notes section to document the details of reporting the incident, including the office reported to, date and time reported, and any additional information discussed.
15. Review all entries for accuracy and completeness before saving your changes.
16. Once completed, download, print, or share the form as needed.

Complete the Employers Worksheet For Reporting Serious Injuries Form online today.