Employee statement regarding injury illness incident 2026

1. Click ‘Get Form’ to open the Employee Injury and Incident Report in the editor.
2. Begin by filling out the 'Supervisor Section' with details such as the Date of Injury, Employer Name, and Employee's information including their name, address, and contact numbers.
3. In the 'Injury Type' section, circle the appropriate type of injury sustained. This helps categorize the incident accurately.
4. Next, complete the 'Employee’s Statement' section. Here, provide a detailed explanation of how, when, and where the injury occurred. Be sure to note any pain experienced and its development over time.
5. Indicate if first aid was given or if medical treatment was required. If so, include details about the physician or hospital involved.
6. Finally, ensure that both you and your supervisor sign off on the document before submitting it to Human Resources within 24 hours of the incident.

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