# First Report of Injury Form # 1st Report of Injury Form ### **LINK TO EDITABLE DOCUMENT:** [Click Here - Editable Employee Report (Recordable/Report Only)](https://forms.office.com/r/CwvUF6DUGC) # First Report of Injury SOP **FIRST REPORT OF INJURY ** **STANDARD OPERATING PROCEDURE** **1.0. Purpose:** The purpose of this SOP is to provide a clear and consistent procedure for employees and supervisors to follow in the event of a work-related injury or illness. This ensures that injured employees receive prompt medical attention, all incidents are properly documented, and the company remains compliant with state and federal regulations, such as those from the Occupational Safety and Health Administration (OSHA). **2.0. Scope:** This procedure applies to all employees, contractors, and temporary staff working on company property or in the course of their employment. It covers all injuries, regardless of severity, including those requiring only first aid. **3.0. Responsibilities:** **3.1. **The Injured Employee is responsible to: a. Immediately report any work-related injury or illness to their immediate supervisor. b. Call the nurse triage line (MedCor) **1-844-334-6477** to receive proper medical advice. Record the incident number provided by the triage line. c. Complete “First Report of Injury Form” on the Safety Portal within 24 hours of incident. **3.2. **The employee’s supervisor or senior leadership on site is responsible to: a. Ensure the safety of the employee, initiate medical care, if necessary, b. Assist in completion of the "First Report of Injury" form if the injured employee has not already done so. **c. **Contact Human Resources to report the injury. **3.3. **Human Resources and Safety and Compliance Manager is responsible to: a. Manage the official workers' compensation claim. b. Coordinate with insurance carriers. c. Ensure all reporting deadlines are met. d. Investigate the injury, if required. **4.0. Procedure: Immediate Response:** **4.1. **Employee Actions (upon injury): a. Assess the situation and ensure immediate safety**.** Move away from any ongoing hazards if it is safe to do so. b. Notify your immediate supervisor of the injury as soon as possible. If the supervisor is unavailable, notify the senior leadership on site, or HR representative. c. **Contact the Nurse Triage Line (Medcor) (1-844-334-6477) **to get prompt, professional medical advice. Record the incident number provided by the triage line. d. Provide factual details about the incident in the first report of injury form (within 24 hours), including what happened, where it happened, and how the injury occurred. e. Do not delay reporting, even for seemingly minor injuries. Delaying may jeopardize your workers' compensation benefits. **4.2. **Supervisor Actions (upon notification): a. **Ensure employee safety:** Take immediate action to stabilize the situation and prevent further harm. If there is a life-threatening or serious injury, call 911 immediately. b. **Secure the scene:** If a hazard remains, cordon off the area to prevent others from getting injured. c. **Arrange for medical care:** 1. **Emergency:** For severe injuries, call 911. 2. **Non-Emergency:** If the employee requires non-emergency medical attention, coordinate for transportation to the nearest Urgent Care facility or ER. Provide the facility with the claim # from the nurse triage line. Inform the provider that it is a work-related injury. **4.3. **Do not transport a severely injured employee yourself**.** Wait for trained emergency personnel. **4.4. **Initiate documentation by gathering details about the incident and any witnesses. **4.5. **Employee shall provide all copies of the treatment plan, follow-up appointments, and any work restrictions to their HR Generalist and Safety and Compliance Manager. **5.0. Procedure: Documentation and Reporting:** **5.1. **Supervisor Actions **(within 24 hours of incident):** a. Ensure Completion of the "First Report of Injury" form**.** Use the official company form within the Safety Portal. b. Include a statement directly from the injured employee. **5.2. **Human Resources/Safety and Compliance Manager Actions: a. Review the First Report of Injury form and ensure all required information is complete and accurate. Contact the injured employee or witnesses listed with any questions. c. Make sure the claim is filed with the workers' compensation insurance carrier within the state-mandated timeframe. In Wisconsin, this is within seven days for insured employees. d. Provide a copy of the completed form to the injured employee for their records if requested. e. Notify OSHA for serious injuries, including fatalities, in-patient hospitalizations, amputations, or loss of an eye, according to federal reporting timelines. f. Maintain confidentiality of the employee's personal and medical information throughout the process. g. Gather witness statements**.** Interview any witnesses and submit their signed statements in the SharePoint file. h. Follow up with injured employee**.** Keep in contact with injured employee throughout the course of treatment. **6.0. Incident Investigation:** a. The Safety and Compliance Manager will conduct a thorough investigation of the incident to identify the root cause and determine any corrective actions. b. An investigation report shall be submitted to the necessary parties.** ** **7.0. Record-Keeping:** 7.1. A copy of all First Report of Injury forms, witness statements, and related documentation will be kept on file within the SharePoint to comply with regulatory requirements.