Employee Report Of Injury Form. Department of labor (see instructions on reverse) office of workers' compensation programs omb no. Employers must report any worker fatality within 8 hours and any amputation, loss of an eye, or hospitalization of a worker within 24.
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Web this incident report form template provides space to record all employees involved in the incident, identification numbers of equipment. 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. Department of labor (see instructions on reverse) office of workers' compensation programs omb no. 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.
This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees. This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees. Web employer's first report of injury. 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. Employers must report any worker fatality within 8 hours and any amputation, loss of an eye, or hospitalization of a worker within 24.
