Get Manager's /supervisor's Report Of Employee Injury Or Illness ... - Csupomona

Filling out the Manager's /Supervisor's Report Of Employee Injury Or Illness is a critical process to ensure timely reporting and effective management of work-related injuries or illnesses. This guide provides step-by-step instructions to help managers and supervisors complete the form online with ease.

Follow the steps to accurately complete the report.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date of your knowledge or notice of the employee's injury or illness in the designated field.
3. Fill in the employee's name, date of birth, and both home and mobile phone numbers as required in the appropriate sections.
4. Provide the employee's occupation or regular job title, as well as the department where they are employed.
5. Indicate the employee's usual work schedule, including hours per day and total weekly hours, selecting their employment status from the given options.
6. Record the date and time of the injury or onset of the illness, and if applicable, check the box indicating if the employee is still off work.
7. Describe the location where the injury occurred, including specific details like building and room numbers if it is on campus.
8. Detail the specific injury or illness and the part of the body affected in the provided field.
9. List the equipment, materials, and chemicals the employee was using at the time of the incident.
10. Explain the specific activity the employee was performing when the event occurred.
11. Provide a narrative describing how the injury or illness occurred, specifying actions that led directly to the event.
12. Document where the employee received their initial medical treatment, providing full names of facilities.
13. State any corrective or preventive action taken in response to the incident.
14. Include names of witnesses who were present during the incident.
15. Indicate whether the facts suggest the injury happened at work by checking the appropriate box.
16. Print the name and signature of the manager/supervisor completing the report, along with their extension number.
17. Ensure that the Workers’ Compensation Coordinator's signature section is filled, including their extension number.
18. Once the form is completed, save changes, and download or print as needed for submission.

Complete your documents online today for efficient and accurate reporting!