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Supervisor's Accident Packet

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Form A:
Supervisor's Injury Report

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Form C:
Supervisor's Property Damage Report

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Form B:
Supervisor's Spill Report

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Form D:
Supervisor's Incident Report (General)

For serious incidents that involve significant injury or property damage, or that impact a location's ability to operate, immediately notify your site's EHS Representative and Operations Manager via phone for guidance and response.

Supporting Documents

Declination of Medical Treatment

Witness Statement

Injury Flow Chart

MI WC Panel Provider List

NY WC Panel Provider List

PA WC Panel Provider List

OSHA Inspection Guide

Return to Work Checklist

Concentra Treatment Authorization Form

PA Worker's Compensation Rights & Responsibilities Form

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