- Employee must report to the attending supervisor immediately and provide a signed statement for the A/I report (separate form*).
- Witnesses must also provide a signed statement for inclusion in the report.
- Supervisor will conduct the preliminary investigation as outlined below, and report accordingly:
- If an emergency, notify Security (x3500) immediately for response services.
- If situation requires formal investigation and/or hazard elimination; OR if medical treatment beyond basic first aid is needed; OR if lost time is anticipated, first notify Human Resources (x3837) and then the EHS Manager (x3763) immediately.
- File the written accident/incident report first with HR within 24-hours regardless and a copy to EHS for remediation.
- If the accident/incident involved chemical exposure, a copy of the MSDS sheet must be attached to the report.
Important Filing Instructions: Required fields are marked with an asterix (*). After completing this form, you will receive an email confirmation. You must print the email confirmation and all parties must sign that copy. The supervisor should retain the signed copy in their file.