Fillable Online SUPERVISOR INJURY CHECK LIST Fax 2026

1. Click ‘Get Form’ to open the Fillable Online SUPERVISOR INJURY CHECK LIST Fax in our editor.
2. Begin by entering the employee's name and date of injury/illness at the top of the form. This information is crucial for record-keeping.
3. In Section A, if the employee is seeking treatment, check the appropriate boxes and ensure all required forms are listed. Provide these forms within 24 hours.
4. For employees not seeking treatment, complete Section B of the Workers’ Compensation Acknowledgment Form (WC Form 35) and have them sign the Declination of Treatment Statement.
5. Ensure that all necessary reports, such as the Immediate Supervisor’s Report of Employee Injury (Safety Form 674), are completed and sent to the relevant divisions.
6. Review all entries for accuracy before saving or printing your completed form. Utilize our platform's features to easily share or store your document securely.

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