Employee Injury Report Form and Policies
Ninety percent of employee accidents are caused by carelessness, lack of attention, hurrying, using the wrong equipment (i.e. chair instead of ladder), or lack of proper instructions for use of equipment or chemical. Please slow down and ask questions to help prevent accidents.
All accidents, no matter how minor, must be reported immediately to your Supervisor or the Business office, no later than by the end of your shift. If capable, the injured employee must fill out the Employee Incident/Workers Compensation Report Form (located below). If the injured employee is not capable of filling out the report themselves due to the nature of the injury, the employee's Supervisor will make a complete investigation and write an incident report in full, and if
necessary, will make sure you receive the proper medical attention. Employees should be directed to a designated medical provider for all treatment of work-related
Without the incident report, if injury shows up later, it is hard to prove that it is a “work related” injury.
If medical attention is necessary, the person in charge will fax the appropriate paperwork to the clinic or hospital where you will be treated. If the accident is emergent in nature, meaning you cannot wait until your Supervisor is contacted for direction, go to the nearest emergency room. Immediately report it to your Supervisor at the earliest time possible.
It is the policy of POI, Inc. to provide modified or alternate work, if available, for employees injured on the job, who are unable to temporarily or permanently return to their regular job classifications. Employees who are off work due to personal injuries/illnesses may be required to complete functional capacity examinations before they can return to their former jobs. When an employee’s personal injury/illness has reached maximum medical improvement and there are restrictions that allow the employee to perform the duties of the employee’s job, POI, Inc. will return the employee to work in their former job. If the permanent restrictions resulting from an employee’s personal injury/illness prohibit the employee from performing their job’s essential functions, the employee shall be referred to their Supervisor for job placement if a job is available within the employees restrictions. If no jobs are available, the employee will be laid off. If the employee rejects any assignment which is compatible with medical restrictions, the employee shall not be compensated by POI, Inc. or the workers’ compensation carrier with temporary, partial, temporary total or healing period benefits during the period of refusal.