Get (kemi No

Filling out the (KEMI No form is an essential process for reporting incidents accurately and efficiently. This guide will help users navigate the various sections of the form with detailed instructions to ensure all necessary information is captured correctly.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. In Part 1, provide your name as the employee or first responder along with your employment status (full, part-time, seasonal, or temporary). This information is crucial for identifying the individual involved.
3. Next, enter the date and time of the incident in the specified formats (mm/dd/yy and hh:mm). Ensure accuracy as this information is key to the report.
4. Fill in the incident location and provide a clear description of how the incident occurred, including the type of injury and specific body parts affected.
5. Indicate whether the report is for reporting only or if actions were taken, including any treatment received. This detail assists in understanding the context of the incident.
6. For work comp claims, specify if the employee has returned to work, and provide their date of birth, mailing address, and phone number to complete their identification.
7. Incorporate the job title, the date and time the employee started work on the incident date, last date worked, and the start date of any disability, if applicable.
8. In Part 2, the supervisor or department manager needs to confirm if a police report was filed and whether a seat belt was in use at the time of the incident.
9. Indicate if a cell phone was in use during the incident. Collect witness information, including names and phone numbers.
10. Document any available photos and detail the activity, along with equipment, materials, or chemicals in use at the time.
11. Assess whether the incident was due to an unsafe act or condition and provide the name of the person filing the report.
12. Finally, review your form thoroughly and click on the large red button to email it to the HR manager and safety coordinator. Make sure to print a copy if necessary for your records.

Complete your incident report online today to ensure a smooth and efficient submission process.