How to write my Employee Injury Report Form document

Employee Injury Report Date Reported. current date Employee. contract first name contract last name Department. department Supervisor. supervisor manager Date Time of Injury Insert Injury Date and Time Employee Job Information Position. contract job title Number of Months in Current Position. Date of Hire. Work Type. Hourly Salary Shift Type. Day Night Swing Other Instructions. Supervisor must complete the following form and file it with the Human Resources Department. Description of Incident Injury Describe the injury as well as the events or what happened to cause this injury. Attach additional pages if necessary.

Witnesses Did anyone witness the incident and or injury. Yes No. Name of Witnesses. Care Taken Aid Rendered First Aid. Hospital Urgent Care. Primary Care Physician Clinic. Ambulance. No action taken. Other. Hospital Physician Information. Name Address Phone Notes. Supervisor Signature Date For Office Use Only Recieved By signator authorized signature or signer.

Human Resources Manager Date Include Employee Contact HR Information company name address address city state or province zip or postal code Phone phone number

and so on...

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The editable Employee Injury Report Form template - complete with the actual formatting and layout is available in the retail Contract Packs.

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Document Length: 2 Pages

Usage: Report an injury on the job

Use the Employee Injury Report Form when an accident or injury occurs on the job. This form outlines what happened and what steps were taken, including supervisor signoffs.

 

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Legal Contract Templates

Related documents may be used in conjunction with this document depending on your situation. Many related documents are intended for use as part of a contract management system.

Related Documents:
Employee Injury Report Form
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How do you write a Employee Injury Report Form document?

Employee Injury Report Date Reported. current date Employee. contract first name contract last name Department. department Supervisor. supervisor manager Date Time of Injury Insert Injury Date and Time Employee Job Information Position. contract job title Number of Months in Current Position. Date of Hire. Work Type. Hourly Salary Shift Type. Day Night Swing Other Instructions. Supervisor must complete the following form and file it with the Human Resources Department. Description of Incident Injury Describe the injury as well as the events or what happened to cause this injury. Attach additional pages if necessary.

Witnesses Did anyone witness the incident and or injury. Yes No. Name of Witnesses. Care Taken Aid Rendered First Aid. Hospital Urgent Care. Primary Care Physician Clinic. Ambulance. No action taken. Other. Hospital Physician Information. Name Address Phone Notes. Supervisor Signature Date For Office Use Only Recieved By signator authorized signature or signer.

Human Resources Manager Date Include Employee Contact HR Information company name address address city state or province zip or postal code Phone phone number

Writing the Company Vacation and Sick Leave Policy document (alternate or related contract document)

company name VACATION SICK LEAVE AND TIME OFF POLICY This document provides company name employees with important information and guidance concerning company names policies and procedures its code of conduct its stated mission and goals and all other organizational policies that govern all Vacation Sick Leave and Time Off taken by employees of company name. This document should not be considered complete and comprehensive guide as to what is acceptable behavior or company policy but should serve as guide to aid staff with the most common or frequent questions and concerns they may have. Policies procedures and guidelines contained in this policy are subject to change and all staff are encouraged to consult Human Resources Manager should they have any questions that do not appear to be covered here. In all cases the policies stated in the Human Resources Guide shall prevail in the event of any conflict between the information contained in the Guide and verbal statement about the Human Resources Guide or other Company policies or procedures. Each employee must read and become familiar with these policies and procedures and refer to this policy if they have questions and concerns about Vacation Sick Leave or Time Off requests and the company policies or procedures that govern such requests.

Definitions of Personnel Full Time Employees shall be defined as all employees or agents of the company who are scheduled or authorized to work or more hours per week and who have been recognized by the Company Human Resources department as full time employees and for whom written contract is on file with the Company Human Resources Department. Part Time Employees shall be defined as all employees or agents of the company who work less than hours per week and who have been recognized by the Company Human Resources department as Part time employees and for whom written contract is on file with the Company Human Resources Department. Contract Employees Contractors Subcontractors shall be defined as all personnel or agents of the company who have temporary employment contract with the company regardless of how many hours they work per week. Responsibility of Company Company shall be responsible for distributing to all new employees part time employees contractors and other staff copy of the Vacation Sick Leave and Time Off Policy in print or electronic format s. Responsibility of Employees Vendors Contractors and Other Staff This Vacation Sick Leave and Time Off Policy will also serve as guide to the benefits offered to employees by the Company. These policies and benefits are subject to change at the Companys sole discretion and are not intended to be part of any compensation agreement or promise. Vacation Leave

Full Time Employees and Full Time Temporary Employees are entitled to time off with pay for vacation or other personal reasons. An employee accrues vacation leave credits for all hours in which he or she works. Vacation leave may be used for. a normal work hours b paid vacation leave c paid sick leave

d paid jury duty e paid military leave. Accrual of vacation leave is as follows. Full Time Employees and Full Time Temporary Employees with less than months of continuous service with the company shall earn vacation leave at the rate of days or hours per calendar year. Maximum Accrual Full Time Employees and Full Time Temporary Employees may accrue vacation leave up to maximum of hours. After hours have been accrued an employee shall not accrue any additional hours until the employee reduces the total number of accrued hours to less than total hours.

Vacation Leave Accrual for Partial Employment Full Time Employees and Full Time Temporary Employees shall earn vacation leave at the full monthly rate when in pay status for fifteen or more calendar days during the pay period. When working less than fifteen days during the pay period employees will not earn vacation leave. Scheduling and Approval of Vacation Leave Employees must request all vacation leave that totals five or more consecutive days at least four weeks in advance of the date that the leave is requested to take place. Vacation leave that totals four days or less must be requested at least two weeks in advance of the date that the leave is requested to take place. All leave is subject to the approval of management and employees must make their request using the Company Vacation and Time Off Request Form. Requests for leave that are not made through the Company Vacation and Time Off Request Form shall be deemed inappropriate and shall not constitute official notification to the company of the Employees request for leave. This includes authorization made through verbal email or written formats not using the Company Vacation and Time Off Request Form. Sick Leave Full Time Employees and Full Time Temporary Employees shall earn sick leave. Employees may take sick leave for the following. a personal illness or injury b illness or injury of an immediate family member The definition of immediate family member shall be the employees wife husband life partner father mother brother sister child and corresponding in laws.

Employees are required to notify and report to their supervisor or manager prior to an absence for sickness or injury at the earliest opportunity. Employees must detail the reason for the absence and when they expect to return to work. Employees who do not communicate with their supervisor or manager for three consecutive days of absence may be considered as having abandoned their jobs and subject to termination. Accrual of Sick Leave Full Time Employees and Full Time Temporary Employees accumulate sick leave at the rate of one workday hours for each full month worked. Earned sick leave may not be carried over from year to year. Full Time Employees and Full Time Temporary Employees shall earn sick leave at the full monthly rate when in pay status for fifteen or more calendar days during the pay period. When working less than fifteen days during the pay period employees will not earn sick leave. Use of Sick Leave Full Time Employees and Full Time Temporary Employees may be granted sick leave when they are unable to perform their duties because of personal illness or injury or illness within their immediate family or because they must be absent from work for the purpose of obtaining health related professional services that cannot be obtained after regular working hours. Sick leave is privilege as opposed to an earned right and must be accrued before it can be used.

Recording of Sick Leave Departments and administrative offices will maintain record of sick leave accrued by each employee. Absences due to sick leave should be documented on the Companys Annual Sick Leave Form and reported on the Monthly Service Report by department heads or supervisors who should enter the appropriate hours of each day of absence. The minimum time to be recorded for part of any workday charged as sick leave is thirty minutes. Abusing Sick Leave Managers or supervisors who believe that an employee may be abusing sick leave or is claiming sick leave under false pretense may require evidence of illness or injury in the form of statement from physician or other medical certification. The Company reserves the right to grant temporary approval of sick leave subject to the receipt of sufficient evidence of illness or injury. Evidence of abuse of Company sick leave is grounds for disciplinary action including termination. Employees who claim sick leave for the purpose of applying for another job working second job or any other activity that is not illness or injury related shall be considered to be engaging in misconduct and dishonest behavior and may be subject to immediate termination.

Payment for Sick Leave on Termination or Separation There shall be no payment for accrued or unused sick leave for employees upon termination or separation from the Company. Family Leave Under special circumstances employees may request an extended family leave for personal reasons. Company grants employees who must be absent for personal reasons for up to six months the Family Leave Term Family leave without pay may be requested by employees for the following reasons. a the birth or adoption of child b serious personal illness c the serious illness of an employees immediate family as previously defined above. Family Leave Qualifications Time off for family leave is available to all Full Time Employees or Full Time Temporary Employees who have worked minimum of 250 hours over the previous 12 month period.

When possible employees are asked to submit family leave requests days in advance. The Company recognizes that taking time off for family leave may not be foreseeable event and will consider all of the situations and circumstances under which approval for the leave is being requested. Before family leave is granted employees must first exhaust all available sick and vacation leave. The Company will continue to underwrite any healthcare benefits during the family leave so long as the employee returns to work after the family leave is complete. Company reserves the right to recover all amounts it subsidizes or pays for health insurance for the employee if an employee does not return to work from family leave. An exception shall apply in the case where the employee cannot return to work because of his or her continued illness or that of family member. All sick leave vacation leave retirement credits or other benefit credits shall not accrue while the employee is on family leave. An employee while on family leave who is found to have applied for work accepted position or is employed by another company will be immediately terminated and the Company shall recover all costs associated with the employees family leave. Any employee failing to return to work from family leave as indicated on the Family Leave Term or failing to properly explain the absence to the Company Human Services Department will be considered as having voluntarily terminated his or her position.

Military Leave Full Time Employees and Full Time Temporary Employees are entitled to military leave of absence when ordered to active duty for training as members of the National Guard or the U. S. Armed Forces. Regular Full Time Employees and Full Time Temporary Employees who are ordered to active duty or drafted shall be entitled to reinstatement to their former positions or comparable positions with the same salary or pay grade. Employees placed on extended military leaves of absence will not receive pay from the Company nor accrue annual vacation or sick leave. Military Leave for Training Full Time Employees and Full Time Temporary Employees who are required to become active duty personnel for the purpose of attending training or other active duty events shall not suffer any loss of their regular pay during the first twenty one days of their absence from work. All Full Time Employees and Full Time Temporary Employees are required to provide copy of their training orders or other paperwork to their supervisor or manager and their Human Resources Department. Administrative Leave Disciplinary Regular Employees and Full Time Temporary Employees placed on disciplinary administrative leave by the Company shall be subject to the Company Disciplinary Guidelines as defined in the Company Disciplinary Handbook. Employees placed on administrative leaves of absence will not receive pay from the Company nor accrue annual vacation or sick leave. Administrative Leave Non Disciplinary Regular Employees and Full Time Temporary Employees placed on non disciplinary administrative leave by the Company shall be subject to the Company Disciplinary Guidelines as defined in the Company Disciplinary Handbook.

Jury Duty or Witness Summons Regular Employees and Full Time Temporary Employees selected for jury duty or to give testimony in court proceeding that is not of their own making may request to take sick time off for the days they are required to be absent. Bereavement Leave Regular Employees and Full Time Temporary Employees shall be granted up to three days per year of bereavement leave for the death of spouse child parent life partner brother or sister grandparent grandparent in law grandchild son or daughter in law mother in law father in law brother in law sister in law stepchild child in law aunt uncle niece nephew and first and second cousin. All other relationships shall be excluded unless in the case where the employee is guardian. All bereavement leave is non accumulative. The total amount granted by the Company to an employee shall not exceed three days within any calendar year. If additional days of absences are required the employee may request sick leave or vacation leave. Time Off for Religious Observances and Work Schedules

If an employee needs accommodations for religious holiday or belief the Company will attempt to aid the employees wishes provided such accommodations do not affect the safety and health of other employees; that no undue hardship is created for the Company or its employees; and that the accommodations do not violate the standards set forth in the Company Human Resources Guide. Holidays The Company will be closed for normal business operations in observation of regular holidays and other holidays as determined by the management and posted by the Human Resources Department. Regular Employees and Full Time Temporary Employees who are not required to work will be excused on such days without being charged leave or losing pay. In the event such staff members are required to work on holiday they will be granted another holiday or be paid in accordance with the Companys overtime policy. Regular Holiday Schedule Labor Day 1st Monday in Sept.

Thanksgiving Day 4th Thursday in November Christmas Day December 25th New Years Day January 1st Memorial Day Last Monday in May Independence Day July 4th The Human Resources Department will post the yearly schedule of holidays. Contact Information

Questions comments or concerns regarding the Vacation Sick Leave and Time Off Policy may be directed to hr human resources email or to the following Human Resources Department or Company representative. hr human resources contact name Changes to this Vacation Sick Leave and Time Off Policy The practices described in this Vacation Sick Leave and Time Off Policy are current as of current date. company name reserves the right to modify or amend this Vacation Sick Leave and Time Off Policy at any time. Appropriate notice will be given to all employees concerning such amendments. Effective Date. current date

Writing the Employee Absence Report Form document (alternate or related contract document)

company name Employee Absence Report Date Reported current date Employee. contract first name contract last name Job title of signator authorized signature or signer. contract job title Department. department Supervisor. supervisor manager Period of Absence start date to end date Instructions. Supervisor must complete the following form and file it with the Human Resources Department. Reason for Absence Notification Method Phone. Writing. Other. Notes. Action Taken Pay Deduction. Vacation Personal Leave Deduction. Made up time. No action taken. Other. Notes.

Supervisor Signature Date address address city state or province zip or postal code Phone phone number

How do you write a Employee Salary Reduction Letter document? (example of another included contract document)

company name SALARY REDUCTION NOTICE current date To. contract first name contract last name contract job title Re. Notice of Salary Reduction Dear contract first name contract last name.

This is notice by company name that effective start date your salary will be reduced from Insert Old Salary to Insert New Salary This action is being taken as result of. Insert reason for salary reduction such as union agreement or an overall cutback in salaries. This salary reduction shall be in effect as of start date. If you have any questions please contact the Human Resources Manager. Sincerely Human Resources Manager Department cc. Human Resources Manager

Department Manager Personnel File address address city state or province zip or postal code Phone phone number

How to write my Jury Duty Release Request Letter document (example of another included contract document)

company name REQUEST FOR RELEASE FROM JURY DUTY current date Re. company name Request for Release of contract first name contract last name from Jury Duty DISCLAIMER. It is the legal responsibility of each citizen to obey instructions from the court and no other organization or company is authorized to absolve any citizen of those responsibilities. To Whom It May Concern. This letter is to inform you that contract first name contract last name is employed with us in good standing on full time basis as contract job title. The work currently performed by contract first name contract last name is time sensitive and affects many other parties within and outside of our company.

For this reason we respectfully request that contract first name contract last name be released from jury duty. The branch location where the employee works is. company name address address city state or province zip or postal code Phone. phone number Please feel free to contact our Human Resources department at the number above if you require additional information.

company name By signator authorized signature or signer. Job title of signator authorized signature or signer. Date when the contact was signed Human Resources Department

A Document from Contract Pack

The editable Employee Injury Report Form template - complete with the actual formatting and layout is available in the retail Contract Packs.

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