Workers’ Compensation Incident Checklist and Report

Incident Report completed by employee (due same day)
All necessary parties informed
Drug screen performed (if reasonable basis to suspect that drug or alcohol use could have contributed to the injury/accident)
WC Claim filed with ABC Insurance Company (within 24 hours)
OSHA Form 300 and 301 completed (if recordable)
Accident Investigation completed by supervisor (due within 48 hours)
Supervisor notified of upcoming appointments (PT, follow-up, referrals)
Employee reimbursed for mileage (if necessary)

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