Get Ut Employee Injury Report Form 2011-2025

Completing the UT Employee Injury Report Form online is an essential step for documenting workplace injuries. This guide provides clear, step-by-step instructions to ensure users can effectively fill out the form accurately and efficiently.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the employee's details in the designated fields. This includes the injured person's name, social security or EIN number, and title.
3. Provide the home address, home phone, work phone, and cell phone number to ensure proper contact information.
4. Enter the date of birth, assignment location, and the specific location of the incident.
5. Fill in the injury date and time, making sure to specify whether it occurred in the morning or afternoon.
6. Indicate the name of the supervisor notified about the incident, along with the date and time of the notification.
7. Detail the incident by providing a specific description in the text box. Be thorough and clear.
8. Select the treatment type that applies from the options provided, such as no treatment needed, outpatient, or hospitalization.
9. If treatment was rendered, fill in the physician's name, address, and any relevant hospital information including phone number.
10. Indicate whether the employee left work, including the date and time, as well as when they returned.
11. Document the body part injured, type of injury, and the cause of the injury.
12. Answer the questions regarding the nature of the injury, specifically if it happened during regular duties and if it occurred on the company's premises.
13. Provide details about any prior injuries to the same body part if applicable.
14. Include information about any individuals dependent on the employee, along with their relationship and birth dates.
15. Document any equipment or materials involved in the incident and whether the accident was caused by equipment failure.
16. Fill in the witness information section, including names, titles, and contact details.
17. In the comments section, describe what was happening at the time of the accident, the events leading up to it, and provide recommendations to prevent future incidents.
18. Finally, review all entries for accuracy before saving the form. You can then save changes, download, print, or share the completed report.

Complete your UT Employee Injury Report Form online today to document workplace incidents efficiently.