Get Www2.augie.eduincident-report-formincident Report Formaugustana University

This guide provides a clear and supportive overview of how to complete the Augustana University incident report form online. By following these steps, you can ensure that all necessary information is accurately recorded for incidents involving injuries or illnesses.

Follow the steps to successfully complete the form.

1. Press the 'Get Form' button to access the incident report form and open it in your preferred online editor.
2. Begin by filling in the claim number assigned by the traveler's insurance, if applicable. If not applicable, you may mark it as 'NA'.
3. Provide the social security number of the employee involved, followed by their full name, date of birth, and date of hire. Ensure that all personal information is accurate.
4. Indicate the employee's gender by marking either 'Male' or 'Female'.
5. Enter the employee's wage, job title, and department along with the name of their supervisor.
6. Provide both home and work phone numbers for the employee.
7. Answer the question regarding if the employee works for other departments on campus.
8. Document the time the employee began their shift, noting whether it is AM or PM.
9. Select whether the event occurred before, during, or after the scheduled work shift.
10. Input the date and time of the injury and the date the incident was reported.
11. Indicate whether the reported injury led to various medical responses by checking all applicable boxes.
12. Provide the complete home address of the employee involved in the incident.
13. Describe the incident in detail, including what the employee was doing and any relevant chemical exposure.
14. Specify the nature of the injury, the location of the incident, and parts of the body that were injured.
15. List any witnesses along with their contact information.
16. Discuss the factors that contributed to the incident, such as conditions or equipment.
17. Document any medical care provided, including the date of service and by whom.
18. Indicate if the employee was hospitalized and where.
19. Provide the last date the employee worked and offer suggestions for preventing a similar incident in the future.
20. Fill in the name and title of the employee responsible for corrective action along with the date.
21. Complete the employee statement section with relevant details about the incident.
22. Circle all injured body parts as a result of the incident.
23. Have the employee sign and date the form to indicate their acknowledgment.
24. Once all sections are completed, you can save the changes, download, print, or share the form as needed.

Complete your incident report online today to ensure swift action and resolution.