Employee injury illness report form: free download. On-line document store on 5y1.org

[DOC File]DOA-6058 Employee Workplace Injury or Illness Report
https://info.5y1.org/employee-injury-illness-report-form_1_7e342f.html
Employees Instructions for filling out this report. Notify your Supervisor and/or Agency's Worker's Compensation (WC) Coordinator immediately in case of an occurrence. Affected employees seeking Worker’s Compensation for workplace injury or illness should …
employee's report of injury form

[DOC File]WKC-12-E, Employer's First Report of Injury or Disease
https://info.5y1.org/employee-injury-illness-report-form_1_5c9d2b.html
This form is for the employer to report every work-related injury to its insurance company. If an employee is out more than 3 days due to a work-related injury, or there is PPD, a copy is to be sent to the Worker's Compensation Division by the employer's worker's compensation insurance carrier, not by the employer (unless the claim is a fatality).
employee accident injury report form

[DOC File]REPORT OF EMPLOYEE INJURY OR ILLNESS - CSUSM
https://info.5y1.org/employee-injury-illness-report-form_1_9301c8.html
REPORT OF EMPLOYEE INJURY OR ILLNESS. ALL INJURIES, EVEN MINOR ONES, MUST BE REPORTED. Complete this report on day of injury or as soon as possible and send to CSUSM Corporation HR Office. All questions are important. Complete in detail. PART I To be filled out, by the injured employee. Department Name of injured
employee injury form printable

[DOC File]REPORT TO BE FILLED OUT BY EMPLOYEE
https://info.5y1.org/employee-injury-illness-report-form_1_6be69a.html
17. Did the employee seek medical treatment as a result of the injury? Yes No (If Yes, check ONE box below) 18. Returned to full duty; no lost time beyond day of injury/illness. 19. Returned to temporary modified duty; (some restrictions) with no lost time beyond day of injury/illness. 20. Sent home per doctor’s order. 21. Date: 22.
first report of injury template

Employee injury illness report form