Washington Supervisor's Report of an Accident

State:
Washington
Control #:
WA-SKU-4008
Format:
PDF
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Description

Supervisor's Report of an Accident

The Washington Supervisor's Report of an Accident is a document that is required to be completed by a supervisor when an employee is injured on the job. This document is used to track the incident, document the employee's medical treatment, and provide information to the employer in order to assess the safety of the workplace and reduce the risk of similar incidents in the future. The report includes information such as the date and time of the accident, the employee's name, the location and type of accident, a description of the injuries sustained, any witnesses to the accident, and any steps taken by the supervisor to ensure the safety of the employee. There are two types of Washington Supervisor's Report of an Accident: the Supervisor's Accident Report and the Supervisor's Accident Investigation Report. The Supervisor's Accident Report is used when an employee is injured on the job and is completed by the supervisor to document the incident. It includes information such as the date and time of the accident, the employee's name, the location and type of accident, a description of the injuries sustained, and any steps taken by the supervisor to ensure the safety of the employee. The Supervisor's Accident Investigation Report is used when an employee is injured on the job and an investigation is required. This document is completed by the supervisor and includes more detailed information such as a detailed description of the accident, a list of any safety violations that may have contributed to the accident, a list of corrective actions taken to prevent similar incidents in the future, and a list of any witnesses to the accident.

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FAQ

Employees injured on the job are to report the injury to their supervisor as soon as possible after the incident/accident, and when it is safe to do so. Near miss accidents or incidents (when an employee nearly has an accident but is able to avoid it) should be reported as well.

The 4 main incident reports that should be on your list are: Near Miss Reports. Near misses are events where no one was injured, but given a slight change in timing or action, someone could have been.Injury and Lost Time Incident Report.Exposure Incident Report.Sentinel Event Report.

Full name of person injured, full name of witness, date, and time of the incident. Name of supervisor. Specific location that the incident occured. Full details of the injury.

Call 1-800-423-7233, option 1 To report an on-the-job fatality, in-patient hospitalization, amputation, or loss of an eye, call 1-800-423-7233.

Any injury at work - including minor injuries - should be recorded in your employer's 'accident book'. All employers (except for very small companies) must keep an accident book.

All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.

Fatality or permanent total disability. Occupational illness to Army Military or DA Civilian personnel. Injury to on-duty DA Civilian personnel. Injury to Army Military on duty or off duty. Damage to Army property.

Why You Should Report Your Workplace Injury. Telling your employer about a workplace accident isn't only considerate, but it is essential to protect your interests and co-worker's interests, even if the resulting injuries are minor. Informing your boss is a key early step in preserving your workplace injury rights.

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Instructions: Complete this form as soon as possible after an incident that results in serious injury or illness. Concrete examples of important parts of.The form is comprehensive enough to serve as both the Supervisor's Report and the template for an accident investigation. The injured employee's supervisor shall complete the Accident Investigation Report immediately following an illness or injury. Describe what happened (Give complete details. Use plain paper and attach if additional space is needed.) 6. Items 1 - 35 — INSTRUCTIONS FOR COMPLETING THE. These instructions are for the supervisor who is receiving an employee's report of incident. Was employee working overtime? Yes. No. If yes, explain: Notice of Injury "C-1" form completed: Yes.

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Washington Supervisor's Report of an Accident