EMPLOYEE REPORT OF INJURY OR OCCUPATIONAL ILLNESS Case No.
Employee Report Of Injury Form. Employers are not required to submit form. Department of labor (see instructions on reverse) office of workers' compensation programs omb no.
EMPLOYEE REPORT OF INJURY OR OCCUPATIONAL ILLNESS Case No.
Employers are not required to submit form. Employers must report any worker fatality within 8 hours and any amputation, loss of an eye, or hospitalization of a worker within 24. Web employer's first report of injury. Web this incident report form template provides space to record all employees involved in the incident, identification numbers of equipment. This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees. Department of labor (see instructions on reverse) office of workers' compensation programs omb no.
Employers are not required to submit form. Web this incident report form template provides space to record all employees involved in the incident, identification numbers of equipment. Department of labor (see instructions on reverse) office of workers' compensation programs omb no. Web employer's first report of injury. Employers must report any worker fatality within 8 hours and any amputation, loss of an eye, or hospitalization of a worker within 24. Employers are not required to submit form. This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees.
