Follow the steps to complete the SUSB3019 form successfully.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by filling out Section 1, which is designated for employee information. Input your last name, first name, home phone number, home address, date of birth, city, state, zip, job title, employee ID number, date of hire, department, work phone, worker's compensation case/file number, and your work shift (AM or PM). Ensure that all fields are completed accurately.
3. Proceed to Section 2 to provide details regarding the injury or illness. Enter the date and time of the incident, location, specific details of the activities preceding the accident, and how the injury or illness occurred. Be as descriptive as possible when detailing the nature of the injury or illness.
4. In Section 3, address medical information. Indicate the type and nature of the injury, the medical treatment received, and whether a prescription was given. Include the date and time of the medical visit, and provide details about the location where treatment was rendered.
5. Fill in Section 4 with witness statements and the supervisor's investigation statement. Ensure witnesses provide their names and signatures, along with the supervisor summarizing the incident and corrective actions if applicable.
6. Review the completed form for any inaccuracies. Confirm that all necessary sections are filled and that any required signatures are acquired.
7. Once reviewed, save changes to the document. You may also download, print, or share the form as required for distribution to the appropriate parties, including Human Resources and Environmental Health and Safety.

Complete your SUSB3019 form online today to ensure proper documentation of your work-related injury or illness.