Michigan Supplemental Report of Fatal Injury (fill-in form)

• Category: Michigan Workers Compensation - Official
• State: Michigan
• Control #: MI-WC-106
• Format: PDF

Description

Supplemental Report of Fatal Injury (fill-in form) The Michigan Supplemental Report of Fatal Injury (fill-in form) is a form used to document the details of a fatal work-related injury. It is required for all workplace fatalities that occur in the state of Michigan. The form is used to collect data that can be used to identify the cause and circumstances of the death, as well as the victim's work and personal history. There are three types of Michigan Supplemental Report of Fatal Injury (fill-in form): 1. The Initial Report of Fatal Injury (fill-in form) is completed by the investigating officer and contains information about the victim, the incident, the worksite, and the safety violations (if any). 2. The Follow-Up Report of Fatal Injury (fill-in form) is submitted by the employer or the employer's representative and contains information about the victim's job duties, the worksite, and any safety measures that were in place at the time of the incident. 3. The Final Report of Fatal Injury (fill-in form) is submitted by the employer or the employer's representative and contains a summary of the incident, the victim's job duties, and any safety measures that were in place at the time of the incident. The Michigan Supplemental Report of Fatal Injury (fill-in form) is an important part of the investigation process for workplace fatalities and helps to ensure that the cause and circumstances of the death are accurately documented.

The Michigan Supplemental Report of Fatal Injury (fill-in form) is a form used to document the details of a fatal work-related injury. It is required for all workplace fatalities that occur in the state of Michigan. The form is used to collect data that can be used to identify the cause and circumstances of the death, as well as the victim's work and personal history. There are three types of Michigan Supplemental Report of Fatal Injury (fill-in form): 1. The Initial Report of Fatal Injury (fill-in form) is completed by the investigating officer and contains information about the victim, the incident, the worksite, and the safety violations (if any). 2. The Follow-Up Report of Fatal Injury (fill-in form) is submitted by the employer or the employer's representative and contains information about the victim's job duties, the worksite, and any safety measures that were in place at the time of the incident. 3. The Final Report of Fatal Injury (fill-in form) is submitted by the employer or the employer's representative and contains a summary of the incident, the victim's job duties, and any safety measures that were in place at the time of the incident. The Michigan Supplemental Report of Fatal Injury (fill-in form) is an important part of the investigation process for workplace fatalities and helps to ensure that the cause and circumstances of the death are accurately documented.