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FIRST REPORT OF INJURY/ILLNESS . EMPLOYEE'S REPORT OF INJURY/ILLNESS upon the completeness of the accident reports and the availability of medical 
 Mine Accident, Injury and Illness Report Describe fully the conditions contributing to the accident/injury/illness, when the employee returns to regular jobta 
 Series Report; One Screen; Multi-Screen fewer nonfatal injury and illness cases in 2015 of occupational injury and illness data directly from employees and 
 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 
 What was the injury or illness? the employee should advise that the accident is work related and that the On-the-Job Accident and Injury Report, 
 This form should be completed by supervisory/management staff to report all incidents, injuries, or illnesses sustained by agency staff. This form should also be 
  Incident Report Forms Flowchart and Post-Accident For employee injuries outside the Role For any occupational injury, illness, 
 SUPERVISOR'S REPORT OF INJURY OR ILLNESS Claim Number This form must be completed thoroughly by employee's supervisor within 24 hours after an accident . PART I 
 Form 122 EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS disclosure of your medical records which are relevant to the industrial accident or illness claim, otherwise
 treatment of employee accidents or injuries at University Health Services.) After Hours Care Injured Employee . 3/15 Employee Accident Report, Page 2 of 4.
 Injury Report & More Fillable Forms, Register and Subscribe Now!Convert PDF to Word,Edit PDF Documents Online,Online Document Editor
 Injury Report & More Fillable Forms, Register and Subscribe Now!Convert PDF to Word,Edit PDF Documents Online,Online Document Editor
 Employee Injury/Illness Report Page 2 (Revised 2/13) SUPERVISOR'S ACCIDENT INVESTIGATION REPORT Injured Worker: Date of Accident: 1) Describe the accident and type 
 Report a Work-Related Accident Employers must immediately report to Cal/OSHA any work-related death or serious injury or illness. To report employee exposure 
 workers compensation - first report of injury or illness. employer (name & address incl zip) or chemicals employee was using when accident or illness

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