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Click ‘Get Form’ to open the Stony Brook PESH Injury Form in the editor.
Begin with SECTION 1, where you will enter your personal information. Fill in your last name, first name, home phone, and address. Ensure accuracy as this information is crucial for record-keeping.
In SECTION 2, provide details about the injury or illness. Specify the date and time of the incident, location, and a description of what occurred. Be as detailed as possible to ensure clarity.
Move to SECTION 3 to document medical information. Indicate the type of injury and any treatment received. If applicable, include details about prescriptions and medical facilities visited.
Finally, complete SECTION 4 by adding witness statements and supervisor investigation notes if necessary. Ensure all sections are filled out completely before submitting.
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The five elements of an incident report are the description of the incident, date and time, location, parties involved, and actions taken or proposed.
What is an injury report?
Injury reporting is the formal documentation and communication of any injury, illness, or accident in the workplace. The report details the incidenthow it happened, how the injury occurred, and the immediate measures taken to address the situation.
What is the phone number for Stony Brook HR?
University Resources Employees who identify themselves as having a disability or present a supervisor with medical documentation seeking a job-related accommodation should be referred to the Human Resource Services Office at (631) 632-6180.
What constitutes an injury report?
An Injury Report is a formal document used to record details about an individuals injury, accident, or incident. It serves as a critical tool for documenting workplace injuries, facilitating timely reporting, initiating investigations, and ensuring compliance with legal and regulatory requirements.
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How does OSHA define a recordable injury or illness? Any work-related fatality. Any work-related injury or illness that results in loss of consciousness, days away from work, restricted work, or transfer to another job.
What type of information is required when documenting an injury report?
The form should include the date and time of the incident, as well as the names of all those involved. The form should also list the sequence of events, and describe any injuries and damage sustained, only the essential information of the incident happened.
Related links
Accident Injury Reporting - Environmental Health and Safety
The following forms must be used to report accidents involving an injury, illness or exposure to chemical, biological or radiological materials.
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