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Employee Incident Report Form

The employee incident report form is the employee’s opportunity to express the details surrounding his/her injury on the job. It gives the details in his/her own words and is often a good tool for corrective actions to prevent the injury from reccuring.

Supervisor’s Incident Investigation Form

The supervisor’s incident report form is the supervisor’s recollection of the details surrounding the employee’s injury on the job. The supervisor’s report will list any details that may correct the problem or to increase awareness in the department and the supervisor and employee.

Employer’s Report Of Employee’s Injury Or Occupational Disease (NCIC Form 19)

The employer’s report of employee’s injury or occupational disease to NCIC (NCIC Form 19) is the one that is used by the Industrial Commission when the injury occurrs on the job — this form includes many details necessary to the compensibility issue and the events which lead up to the inquiry — this form is absolutely mandatory in all cases of injuries on the job.

Note: Industrial Commission regulations require that the notification form be filed with the Industrial Commission within five days after the occurrence and knowledge on an injury; however, OSHA regulations require that injuries requiring medical treatment be recorded by the Environment, Health and Safety office within 48 hours. Therefore, it is imperative that injuries be reported to the Environment, Health and Safety Office as soon as possible.

Workers’ Compensation Forms