Get Customer/visitor Report Of Injury - Maine

Filling out the CUSTOMER/VISITOR REPORT OF INJURY in Maine is a critical task following any injury that occurs on state-owned or controlled property. This guide will provide you with clear instructions on how to accurately complete this form online to ensure timely submission.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to access the report and open it in your preferred editor.
2. Begin by entering the customer or visitor's information in the designated fields. Include the full name, and if the injured person is a minor, be sure to include the name of the parent or guardian.
3. Fill in the mailing address section, ensuring you include the street, city, state, and zip code.
4. Provide daytime and evening telephone numbers to ensure you can be reached for follow-up questions.
5. Indicate the controlling department or agency where the injury occurred.
6. Record the date and time of the injury in the specified format.
7. Describe the exact location of the injury, including the address, city, and state.
8. Clearly detail what injury occurred, mentioning any body parts affected, and explain how and where the injury occurred.
9. List any witnesses to the injury, along with their contact numbers.
10. Indicate the treatment received at the site of the injury, whether it was first aid, ambulance/paramedics, or other specific treatments.
11. Describe any factors, events, or conditions that contributed to the incident.
12. Note whether the customer or visitor expressed any concerns about the incident and provide details if applicable.
13. Complete the report by entering your name, title, date, time, and sign where indicated.
14. Finally, save your changes, and consider downloading, printing, or sharing the form as necessary.

Ensure you're well-prepared by completing your report online today.