Get Injury On Duty Form

Completing the Injury On Duty Form online is a straightforward process that ensures your incident is documented appropriately. This guide provides step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to access the Injury On Duty Form and open it in your preferred document editor.
2. In Section 1, enter your name and professional number in the designated fields. This information identifies you as the person filling out the form.
3. Provide your usual work site, the date and time of the injury, and the specific location of the accident. Be precise to facilitate accurate documentation.
4. List any witness(es) to the injury. Include their names in the appropriate field, which could support your claims regarding the incident.
5. Indicate whether you have lost time from work by checking the 'Yes' or 'No' option. If you check 'Yes', provide details about the date of your first missed day.
6. Give a brief description of how the injury occurred. Include specific information about the part of the body injured and any factors that may have contributed to the incident.
7. Detail what you were doing at the time of the injury in the designated space to further clarify the circumstances.
8. As the teacher, authorize your healthcare providers to share relevant medical information regarding your abilities and limitations related to this claim. Sign and date the form where indicated.
9. In Section 2, ensure your physician fills out the nature and extent of your functional impairment, as well as any relation to pre-existing conditions. They should also confirm their details and sign the form.
10. Finally, after all information is filled in, review the form for accuracy. You can save changes, download, print, or share the completed form as necessary.

Complete your Injury On Duty Form online today to ensure timely processing of your claim.