Montgomery Maryland Reporting Injuries and Illnesses Checklist is a comprehensive tool designed to facilitate the reporting of injuries and illnesses in Montgomery County, Maryland. This checklist provides a detailed framework for organizations and individuals to accurately document and report any incident related to work-related injuries or illnesses in compliance with local regulations and guidelines. The Montgomery Maryland Reporting Injuries and Illnesses Checklist covers a wide range of aspects, ensuring that all relevant information is captured. It includes sections to record the incident details such as the date, time, and location of the occurrence, as well as the nature and extent of the injury or illness. Other essential elements covered in the checklist include: 1. Personal Information: This section prompts for the injured person's name, contact details, employment details, and other identification information to establish appropriate follow-up procedures. 2. Witness Information: In the case of witness involvement, this part collects the names and contact information of any witnesses present during the incident, enabling a comprehensive investigation if necessary. 3. Description of Incident: A detailed account of how the injury or illness occurred is recorded here. It includes factors like the sequence of events, any equipment or machinery involved, and potential contributing factors. 4. Medical Treatment: The checklist requires information related to any medical treatment received or required, including details about the healthcare provider, hospital visits, medication prescribed, etc. 5. Reporting and Notification: This section highlights the reporting and notification procedures to the relevant authorities, such as workers' compensation boards, insurance providers, and employers. It may address specific instructions or deadlines provided by the county's reporting regulation. 6. Supervisor and Management Review: A part of the checklist may include a review process by supervisors and management to ensure that appropriate corrective measures are implemented, preventing future incidents. It's important to note that the Montgomery Maryland Reporting Injuries and Illnesses Checklist may have variations depending on specific industry or occupational requirements. For instance, there could be specific checklists catered to construction, manufacturing, healthcare, or other sectors due to the unique risks and guidelines associated with those industries. These variations aim to address the industry-specific reporting elements and ensure compliance with the relevant safety standards set by the county.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.