Supervisor Report of Injury Incident - Scottsdale Healthcare 2026

1. Click ‘Get Form’ to open the Supervisor Report of Injury Incident in the editor.
2. Begin by entering the name of the injured worker and their employee number or social security number in the designated fields.
3. Record the time and date of the incident, ensuring to specify whether it occurred in the AM or PM.
4. Indicate which side of the body was injured and specify the part of the body affected, such as finger, hand, or arm.
5. Provide a detailed description of the injury or incident, including any relevant circumstances leading up to it.
6. Answer whether medical treatment was sought and where it was provided. Select from options like SHC Corporate Health or Emergency Department.
7. Complete sections regarding work status, including any days away from work due to injury and if accommodations can be made for restricted duty.
8. Fill out investigation details, including witness information and potential causes categorized under unsafe acts or conditions.
9. Finally, ensure that all required signatures are obtained before submitting your report to Disability Management within 24 hours.

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