Get Injuries And Illnesses Incident Report - Summit Safety Group

The Injuries and Illnesses Incident Report is a crucial document for recording work-related injuries or illnesses. This guide provides clear, step-by-step instructions to help you complete this report accurately and efficiently, ensuring that you meet all necessary requirements.

Follow the steps to successfully complete the report.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the employee's full name in the designated field. This should be the individual who is the subject of the report.
3. Next, provide the employee's street address, city, state, and zip code in the corresponding fields to ensure accurate identification.
4. Fill in the employee's date of birth and their date of hire. Knowing how long the individual has been employed may be relevant for certain assessments.
5. Input the case number from the Log of Work-Related Injuries and Illnesses. This helps to keep track of the incident and correlates with other necessary reports.
6. Document the date and time of the injury or illness. Specify the time the employee began work and the exact time the incident occurred.
7. Describe the activity the employee was engaged in just before the incident, including any tools, equipment, or materials used at that time.
8. Clearly explain how the injury or illness occurred, detailing the events leading to the incident.
9. Identify the part of the body affected and the type of injury or illness sustained, using precise terminology.
10. Indicate what object or substance caused harm to the employee. If this does not apply, you can leave this field blank.
11. If the employee has passed away due to the incident, enter the date of death. Otherwise, leave this section blank.
12. Provide information about the physician or healthcare professional who treated the employee, including their name and location.
13. Indicate whether treatment was given at an emergency room, and whether the employee was hospitalized overnight as an in-patient.
14. Once all fields are filled, review the document for accuracy. Save your changes, and prepare to download, print, or share the completed form as needed.

Take action now and complete the Injuries and Illnesses Incident Report online to ensure compliance with regulations.