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Injury Employee: Date of Injury: Dept/Div: Supervisor: Job Title: Phone No: Date Notified of Accident: Date of Investigation: (Circle) : AM PM Shift: A B C Start Time of Work Day: Witnesses (attach statement for each) (Circle) AM PM Time of Injury: Medical Treatment Provided Name: Title: Phone Number: Name: Title: Phone Number: Name: Title: Phone Number: (Circle) Y N Describe the events immediately prior to the injury and the circumstances causing the employees injury:.

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Keywords relevant to Supervisor Investigation Form - Ecsu

  • DEPT
  • indirectly
  • notification
  • Carelessness
  • hr
  • attachments
  • unsafe
  • recommendations
  • Administrator
  • fatigue
  • inadequate
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