The department of labor does not endorse, takes no responsibility for, and exercises no control over the linked organization or its views, or contents, nor does it vouch for the accuracy or accessibility of the information contained on the destination server. Employee's report of injury form instructions: employees shall use this form to report all work related injuries, illnesses, or near miss events (which could have caused an injury or illness) - no matter how minor.
Injury and illness allows users to calculate injury and illness incidence rates for their specific establishment or firm and to compare them with the averages for the nation, for states, and for the industry in which the establishment is found. Tailor your injury and illness prevention program to meet your business' specific safety needs at a minimum, your completed program must be used as outlined for this program to be considered effective. An injury and illness prevention program (iipp) is a basic written workplace safety program that title 8 of the california code of regulations (title 8 ccr) section 3203, requires every employer to develop and implement.
New online reporting for injury and illness forms the department of safety and professional services is excited to announce a new online injury and illness reporting system this online system allows public employers to submit their yearly injury and illness summary through the internet. State of california department of general services office of fleet administration injury and illness prevention plan (iipp) for office of fleet administration (ofa) . This injury and illness prevention program (iipp) template is provided so that all city departments can be in compliance with the requirement of the california code of regulations, title 8, section 3203, to establish a written and effective iipp. The ucla injury and illness prevention program (iipp) is a guide to assist university administrators and supervisors to promote the health and safety of their employees this iipp complies with the cal/osha requirement to provide a safe and healthful. Read template for departments' injury and illness prevention program at the free essay and over 88,000 other research documents template for departments' injury and illness prevention program at the.
Departments at the university of california, berkeley can use the template and forms (including self-assessment forms) listed below to create a written injury & illness prevention program (iipp) that meets the requirements of state law. To assist uc davis departments in establishing and implementing an injury illness prevention program, this injury and illness prevention program (iipp) template has been prepared by the office of environmental health & safety in accordance with university policy (ucd policy & procedure manual section 290-15: safety management program) and. Departments at the university of california, berkeley can use the following template to create a written injury and illness prevention program (iipp) that meets the requirements of state law (each department at uc berkeley is required to have its own iipp. The county of sonoma's workers' compensation program compensates employees for disability leave and medical treatment as a result of a work-related injury or illness learn more about workers' compensation. Template for departments' injury and illness prevention program at the university of california, berkeley revised september 2003 (note: this template was downloaded from the web site of the office of environment.
The oic shall make note of the injury and/or illness in the log relating to the member's name, a brief description of the injury and the current disposition of the case. Illness and injury prevention program (iipp) the injury and illness prevention program (iipp) is a cal/osha required safety program the iipp provides a systematic and agency/department specific occupational safety framework for alameda county agencies and departments. Of 1991, a written, effective injury and illness prevention (iip), program is required for every california employer this manual describes the employers' responsibilities in establishing, implementing, maintaining, an iip. Injury report fields: employee name, department, title, age, sex, date of injury, time of injury did the injury occur while performing a work related activity.
6 section 2 when an injury or illness occurs at work you want to be prepared when an injury occurs at work the following is a checklist you may use as a supervisor to ensure the proper steps are taken.
An injury form template is easy to use and has all the right questions already in place to ask so you don't miss anything yourself most of those are pretty simple on the injury form template and include basic information such as name and description of the injury. This injury and illness incident report is an essential form, but it is not the only form required by law you must also maintain a log of work-related illnesses and an annual summary of occurrences these forms are not provided with this package. Appendix sample accident prevention plan table of contents management policy statement 5 needed to reduce injury and illness exposures in the workplace.