CASES MONTH PB-39 SECTION I - SUMMARY OF MONTHLY EXPERIENCE IRMS REGION STAFF DAYS CASES OF PAGES TOTAL DAYS CASES DAYS MAN HOURS WORKED SECTION II - LOG OF INJURIES (Continue on GSA Form 159 - A if necessary) ENTRY NO. SERVICE AND ORG. CODE DATE OF INJURY NAME GS SERIES/ GRADE NAME OF OCCUPATION 1. 2. 3. 4. 5. 6. REPORT PREPARED BY (Name and title) GENERAL SERVICE ADMINISTRATION DATE PREPARED TRAUMATIC INJURY NATURE OF TYPES OF PARTS OF INJURY/ INJURY/ BODY ILLNE.
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How to fill out the GSA Form 159 online
GSA Form 159 is designed to document monthly logs and summaries of occupational injuries and illnesses reported by regional employees. This guide provides clear, step-by-step instructions to assist users in completing the form online efficiently.
Follow the steps to complete the GSA Form 159 online.
- Click the ‘Get Form’ button to access the form and open it for editing.
- Begin with Section I, where you will summarize your monthly experience by filling in the relevant columns for the total days and cases reported. Ensure to provide accurate figures for man hours worked.
- Proceed to Section II, which is the log of injuries. In this section, you will need to enter details such as the entry number, service and organization code, date of injury, name of the person injured, GS series/grade, and their occupation.
- Detail the nature of the injury or illness by specifying the type and parts of the body affected. You should also have space to list multiple entries if necessary.
- After completing all the required sections, ensure to enter your details in the 'Report prepared by' field, including your name and title.
- Finally, ensure that the form is signed by the regional administrator. After double-checking all entries for accuracy, you can save your changes, download, print, or share the completed form.
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