Incident Reporting Instructions
Employees shall use the incident report form to report all work related injuries, illnesses, or “near miss” events (which could have caused an injury or illness) – no matter how minor. This helps us to identify and correct hazards before they cause serious injuries. This form shall be completed by employees as soon as possible and given to a supervisor for further action.
A Witness Statement is to be completed by any coworkers that witnessed the event.
In the event that an injury causes a need for medical attention, the employee is to be given an "Employee's Choice of Physician" form (C-42). This form must be completed and a medical provider chosen by the employee.
The Supervisor of the Employee is to complete a "Supervisor's Incident Report". It is the responsibility of the Supervisor to investigate the injury, take pictures and suggest processes or procedures that might have prevented the injury and thereby help prevent any future occurrences.
A copy of the completed forms should be forwarded to the office as soon as possible. Please inform the corporate office of all injuries at 901-504-9150 or 901-616-3358
Make sure the employee takes the "Instructions for the Medical Provider" with them. They will need this to ensure the employee is not billed for the medical care received and any invoices are sent to our insurance carrier.
If the employee is given a prescription to be filled, the pharmacy used is to call First Script at 1.800.791.2080 to verify eligibility and temporarily enroll the injured worker. No calls are made to the employer. The approved worker then receives the approved prescription.
All items must be completed on all forms!