Get Accident-illness Report Form - Mcckc

Completing the Accident-Illness Report Form is essential for documenting any incidents within the Metropolitan Community College system. This guide provides clear, step-by-step instructions to assist users in accurately filling out the form online.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Select whether the report is for an injury or an illness by checking the appropriate box. Also, indicate the campus or location where the incident occurred.
3. Provide details about the involved party by checking one of the categories: employee, student worker, or other. Fill in their last name, first name, department, and job title.
4. Enter the last four digits of the social security number or MCC ID number, along with the home address, city, state, and zip code. Include both home and work phone numbers.
5. Indicate the gender and date of birth of the involved party.
6. In the section regarding injury or illness details, describe the incident thoroughly. Include the date and time of the accident, the location, and what the individual was doing prior to the incident.
7. Specify the nature of the injury or illness, including which part of the body was affected. Use the checklist to select the areas affected.
8. Indicate if weather conditions were a factor by selecting 'Yes' or 'No' and providing additional details if applicable.
9. Document whether medical treatment was required, specifying if it took place in an emergency room or if only first aid was administered.
10. Include details regarding the name and address of the medical treatment provider or hospital and the disposition following the injury (e.g., continued work, sought medical attention).
11. In the narrative section, describe all contributing factors related to the injury or illness.
12. List any witnesses along with their contact information in the designated area.
13. If applicable, indicate whether photos or diagrams were taken or drawn, including details about the images.
14. Provide your name, position, and department in the section designated for the person completing the form.
15. Ensure the report is reviewed before submitting, including the signature of the injured party.
16. Finally, save your changes, download the completed form, print it, or share it as necessary.

Start completing the Accident-Illness Report Form online today to ensure your incident is properly documented.