North Carolina Injury Report Form
Description
How to fill out Injury Report Form?
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FAQ
If you are injured at work, or have a work-related illness: Immediately report any work-related injury to your supervisor. If you require emergency medical treatment, obtain care first, and then notify your supervisor as soon as possible after receiving treatment.
All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.
Your employer is required to fill out a form, sometimes called a "First Report of Injury," for every injury which occurs in the workplace. Make sure that your employer fills out a form for you. Review the form to make sure that it is accurate, and request that you be provided with a copy for your own records.
Medical care must be paid for by your employer if you get hurt on the job ? whether or not you miss time from work. You may be eligible to receive benefits even if you are a temporary or part-time worker.
What Should You Include in an Incident Report Form? The day, date, and time of the incident. The type of incident that took place. Where the incident happened. Injuries obtained. Names of the people involved. Equipment involved. Medical treatment that may be required. Eyewitnesses who can tell their perspective.
The First Report of Injury is one of the forms you must fill out for any work related Injury, Illness, or Near Miss. This form along with the Worker's Compensation Form 19 will be used for Worker's Compensation consideration. Return the completed and signed form to EHS Box 8007.
You should immediately report your injury to your employer or immediate supervisor. Your employer must fill out a form, sometimes called a First Report of Injury, for every injury that occurs in the workplace. Make sure that your employer fills out a form for you.
North Carolina Industrial Commission Form 22 is the Statement of Days Worked and Earnings of Injured Employee. This form contains a table wherein the hours worked and wages earned over the 52 weeks prior to the employee's injury are recorded.