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S://mn.gov/omhdd Serious Injury Report Date of report: (If all information is not available within 24 hours, please submit the report with the information you have.) CLIENT INFORMATION First Name: MI: Last Name: Client Facility Name (if applicable): Gender: Female Other Male Date of Birth: Ethnicity: African African American American Indian or Native Alaskan Asian Caucasian or White Choose Not to Respond Hispanic or Latino Other Pacific Islander or Native Hawaiian County of Res.
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2P FAQ
“Serious injuries include death, injuries involving permanent disability, or more than 30 days of absence from work” (Farina et al., 2013, p. 612). “A serious injury or fatality is an incident or near miss that results in or has the potential to produce fatal or life-altering injury or illness” (OSA, n.d.).
Serious injury, as opposed to a chronic illness, is generally defined as physical trauma to the body by an external force that needs immediate hospital or medical treatment. This can be caused by: a fall or burn. an act of violence.
(h) “Serious injury or illness” means any injury or illness occurring in a place of employment or in connection with any employment that requires inpatient hospitalization for other than medical observation or diagnostic testing, or in which an employee suffers an amputation, the loss of an eye, or any serious degree ...
“Serious injury” is defined by Insurance law §5102(d) as: (a) death; (b) dismemberment; (c) significant disfigurement; (d) fracture; (e) loss of a fetus; (f) permanent loss of use of a body organ, member, function or system; (g) permanent consequential limitation of a body organ or member; (h) significant loss of use ...
If you are experiencing any of the following signs, please treat your injury as serious and consult an orthopedic doctor immediately. Pain. Often the most common sign of an acute sports injury is also the most obvious. ... Tenderness. ... Swelling. ... Limited Range of Motion. ... Numbness. ... Contact Our Sports Medicine Specialists.
Severity of injury is a measure of the impact of injury and is described on the basis of six criteria including: nature of injury, duration and nature of treatment, sporting time lost, working time lost, permanent damage and cost.
Death Reporting Forms Death Reporting Form (PDF) Print this document, write the information on the form, and fax it to the OMHDD at 651-797-1950.
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