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01. Edit your dochub online
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- Click ‘Get Form’ to open the pfdfiller in the editor.
- Begin by entering your personal information. Fill in your name, department, phone number, date of birth, and address in the designated fields.
- Next, provide details about the incident. Enter the date and time of the incident along with the city and state where it occurred.
- Indicate your marital status and gender by selecting the appropriate options provided.
- Complete the job title and hire date sections to give context to your employment status.
- In the 'Description of Incident' field, provide a detailed account of what happened during the incident.
- Sign and date the form at the bottom to confirm that all information is accurate.
- For work status, have your supervisor fill out their section regarding treatment referrals and any limitations on returning to work.
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