Employee Injury Supervisor Report Instructions (2023)


Worker's Comp Employee Injury Supervisor's Report Instruction including how to create your Digital Signature in Adobe DC


Today, we're going to be talking about the workers, comp, employee injury supervisors report form it can be found on the lakeshore, employee website or loo under workers.

Comp you'll see the link for the employee.

Injury supervisors report form you click on this.

It will open up a page.

You can click on click here to download the form.

Once the forms been downloaded, you can open it.

It should open up an Adobe, Acrobat Reader if, for some reason your session does not open it up in Adobe Acrobat Reader, please contact the encompass help desk they'll be able to reset your information so that you do open up PDF files in the W Acrobat Reader we're going to be looking at the form itself and how to complete the form.

We're also going to look at the one-time setup of your digital signature.

This is something that you will have to do.

The first time that you go in to set up the digital signature after that you're going to be able to sign by just clicking add the link.

So, let's walk through this form I'm going to enter the employees information so their name, their employee ID number their phone number as you entered the phone number, if you just put it in it, will change the format for it.

The next question is: was it a vehicle accident if yes complete the vehicle accident information section? So if you click on? Yes, if you scroll down to the bottom of the form, you'll see that the vehicle accident information section is highlighted so that you could answer the questions in that section.

If you click on no you'll see that this section is no longer applicable next question: did the employee complete the shift again same thing if you click on? Yes, it does not ask you: what time did they clock out if you click on no trying to ask you for a time that the employee clocked out throughout this form any place that it asked for a time, please enter the time and military and it will put in the am/pm for you date of the injury any of the date fields.

If you look, if you click on the right hand, side.

So prompt you with a calendar so that you can quickly enter in the date time of the injury.

This happened at 8:15 in the morning inserting time of the shift this case here.

The shift started at 7 o'clock in the morning.

If the injury occurred on Lakeshore property you're going to select which region that's you are in, and then the facility within that region, in this case here we're going to use Glade Drive as our test location if it did not occur on lakeshore property, give the full address of where the injury occurred.

In this case, since it happened on Glade, we can leave this box empty in this next section here is documented this area the following.

What did the employee report was the cause of the injury if using tools or equipment, and what was the employee doing with them? What body parts were reported, injury right, side, left side, identify location, a reported injury on the back of this form case here the employer was shoveling the snow on the front walkway at Glade they slipped and fell.

They ended up hurting their left, ankle and left wrist.

Employee complained of severe pain and left, for instance, of the employer, was sent for treatment at Urgent Care again.

One thing to note: do not use names in the description either use consumer or staff which it would be appropriate witnesses again here, if you click on.

Yes, it's going to highlight the section for the witness name and phone number.

If you click on no, it will not ask you for that information.

You was anything that to prevent the injury yes or no did they seek medical treatment if, yes, where, if no you'll see that again, these fields become grayed out in this case here they went to see treatment at urgent care and then again date field for the drop-down box.

Then the drop down at this time here even putting your name, do not sign it as of yet because you have not completed the form we're going to come back to that here in a little bit, did you instruct the employee reports, the injury to the employee reports hotline? So if you did yes, if you reported it, click on yes, now we're going down to the back side of the page or page.

Two of this.

This is where we're going to document where the injuries occurred.

On the right hand, side I'm, going to lift the affected area so left wrist left ankle.

In order for me to be able to highlight the areas on the body parts here, I need to come over here to my menu choices.

Click on comment.

This will add the comment toolbar.

If I look, I have a pencil so draw free freeform.

So this is the left wrist again I'm holding down my mouse while I'm doing this and left knee once I'm done.

Drawing on that, I will come up here and I will close the comments toolbar any additional information other than vehicle information you're going to put into here.

In this case we don't have anything specific with it.

So that completes the form last part that we have is to sign the form you'll see that there is a field here says: supervisor on-call signature.

If you click on this field, right click on it.

It's going to ask you if you want to use one of your pre-existing signatures.

I've already set mine up for this computer.

However, let me walk you through how to do this if you haven't done so yet, you'd click on configure new digital signature or a new digital ID.

We're going to use use this signature.

Digital signature here on the bottom, create your self sign.

Digital ID continue we're going to save it to file and enter some basic information here about yourself.

So your name in this case a for organizational unit, you're, putting your employee, ID organization, name.

Your email address here at Lakeshore again leave the country set for us.

This is the algorithm that it uses to encrypt it.

That's going to be used for digital signatures.

What it does is it takes.

This information makes it a part of the digital signature so that we can verify light around that this.

Is you, and only you, click on continue.

It's going to ask you have two different things or one.

Where do you want to save this information? Again, you want this information to be available to you from any of the devices that you're around, so please make sure that you are saving this to your onedrive.

If you have been converted to onedrive again here on my onedrive I've created a folder for signatures and then I saved my signature file here with that.

Second one here and click on save if you have not been converted to onedrive as of yet, please make sure that you are saving this on your you drive again create a folder first signatures, so it's easier to find it later on.

You're only doing this one time now you're going to create a password.

Please make this password something that you're going to remember, but that's something that other people aren't going to guess right away: you're going to be required to enter this password each time that you want to use your dignity dignity.

That way.

We know that somebody else didn't accidentally, see your signature file and use it.

So we're going to save that now.

If we come down here, you can see that my new one that I just created, is here I'm, going to click on it, I'm going to click on continue, it's going to ask me for that digital or that password that I just created and make sure again.

We want to lock the document after signing once you have signed it.

We don't want changes to happen to this document, so we click on lock document after signing and click on sign.

It's going to prompt you to save this document in some location again.

Make sure that you're saving this to your onedrive.

If you have a folder setup for forms or something like that, you can save it to that location, I'm, going to just use the name of the file and put in the date so that I can find it later on if I need to I'm going to go ahead and click on save now, you'll see that my signature will show here.

It shows us the valid signature as of the date and time that last step that I have to do is to send the file so I'm going to come up here.

Click send file is email attachment to send file again since I'm logged in as myself I'm just going to use my default for Outlook and then I need to send this to workers comp at Lakeshore, CS org, and then please find attached these supervisors report for employee injury dated Oh, 626, 2017 and you'd click on send.

That's all there is to it.

You do have proof of this form that you sent it in your email.

So if you open up your email, go to your sent items, you'll find it in there as far as the actual email that you sent a copy of this form, as well as the location of where you saved it on your onedrive again.

If you have any questions, please make sure to contact the HR department here at Lakeshore.

Thank you.



Employee Injury Supervisor Report Instructions? ›

Make sure your report includes: Full name of person injured, full name of witness, date, and time of the incident. Name of supervisor. Specific location that the incident occured.

Which item should be included in a supervisor's report of employee injury? ›

Make sure your report includes: Full name of person injured, full name of witness, date, and time of the incident. Name of supervisor. Specific location that the incident occured.

How do you write an incident report to a supervisor? ›

What to include in a work incident report
  1. The date and time of the incident.
  2. The name of the witness or author of the report.
  3. A detailed description of the events.
  4. The names of the affected parties.
  5. Other witness statements or important information.
  6. The result of the incident.
Mar 10, 2023

What is the first thing a new supervisor should do when an injury is reported? ›

The first thing a supervisor should do when an injury is reported is to ensure the safety of the injured worker and any other individuals that may be involved. The supervisor should assess the situation to determine if the worker needs medical attention or assistance in the form of first aid.

Should injuries be reported to your supervisor? ›

Telling your employer about a workplace accident isn't only considerate, but it is essential to protect your interests and co-worker's interests, even if the resulting injuries are minor. Informing your boss is a key early step in preserving your workplace injury rights.

What is the responsibility of a manager supervisor regarding accident reporting? ›

Investigate Workplace Accidents:

Supervisors are responsible for conducting accident investigations and for ensuring that all occupationally injured employees report to the Occupational Medical Service (OMS) immediately.

What should not be included in an incident report? ›

Effective Incident Reports need to be clearly written. They should be written so a person that is not involved in the incident can understand what happened. Effective Incident Reports identify the facts and observations. They avoid inclusion of personal biases; they do not draw conclusions/predictions, or place blame.

What is the format of an incident report? ›

Incident reports include all of the facts related to the incident, such as the contact information of the people involved; a description of the incident itself; and any follow-up actions that were taken, like medical treatment.

How do you structure an incident report? ›

It should include:
  1. the names and positions of the people involved.
  2. the names of any witnesses.
  3. the exact location and/or address of the incident.
  4. the exact time and date of the occurrence.
  5. a detailed and clear description of what exactly happened.
  6. a description of the injuries.
Aug 24, 2022

What is the employer's responsibility when a worker is injured? ›

If you have a work-related injury or illness, your employer is required by law to pay for workers' compensation benefits. You could get hurt by: One event at work, such as hurting your back in a fall, getting burned by a chemical that splashes on your skin or getting hurt in a car accident while making deliveries.

What is a supervisor's responsibility when responding to a work-related injury? ›

Supervisor Responsibilities

When an injury does occur, supervisors are expected to directly respond and assist the injured employee in receiving the appropriate medical treatment. A supervisor, should never be in a situation where one of their employees is injured and they don't know about it.

When an employee is injured What is the correct method to report it? ›

If the injured employee needs immediate medical assistance, call 911. If the employee requires medical attention, but 911 isn't needed, a manager should take the injured employee to a medical facility, such as urgent care. The manager should alert the healthcare provider that the injury is work-related.

When should reportable incidents be reported to your supervisor? ›

When should an incident be reported? All incidents, near-misses and injuries should be reported immediately. The incident reporting process will determine the follow-up required, if any. The employee should not have to make a guess as to whether “their issue or incident” is worthy of an incident report.

Are you responsible for safety as a supervisor? ›

Supervisors. Supervisors are directly responsible for the safety and health of employees and other workers that they direct or supervise. Their roles and responsibilities: Ensure the health and safety of all workers under your direct supervision.

Who is responsible for incident reporting? ›

The immediate supervisor or the person responsible for the work area / task or process where an incident occurred or hazard identified is responsible to investigate.

Which occurrences must be reported under the reporting of injuries? ›

Accidents must be reported where they result in an employee or self-employed person being away from work, or unable to perform their normal work duties, for more than seven consecutive days as the result of their injury.

Which of the following items need to be given in an incident report? ›

Incident Reporters can capture date, time, location, witness statements, property damage, environmental damage, weather factors, work permits, scene changes, and more. Link Injuries to the body part(s) and upload relevant photos and documents. Learn more with our Incident Reporting & Investigation System.

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