Test – Supervisor Injury/Illness Investigation Report

Instructions: Complete this form after an incident that results in serious injury or illness.
Must be turned in to Human Resources, no later than 48 hours after the incident.

Step 1: Injured Employee (Complete This Part for Each Injured Employee)

Step 2: Describe the Incident

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.
Attachments can include written witness statements, photographs, maps/drawings, etc.

Step 3: Why Did the Incident Happen?

Step 4: How can future incidents be prevented?