November Safety

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Across
  1. 3. Employees and their (blank) will need to sign the incident report form before sending it to EHS.
  2. 4. The incident report from is also for reporting (blank).
  3. 6. The EHS representative will reach out to any (blank) for statements.
  4. 8. Witnesses may be contacted multiple times depending on the severity of the injury/event.
  5. 10. All three forms can be found within the Versiti (blank) under safety (incidents and injuries).
  6. 11. Remember that all events (injures, illnesses, MVA's, near misses and hazard ID's) should be reported to (blank) ASAP.
Down
  1. 1. The physician at the clinic will add (blank) to the authorization for medical treatment and work status form (if applicable).
  2. 2. If employees receive restrictions from the clinic, or has been advised to miss work (lost days), the EHS (blank) will also need to sign off on the incident report form.
  3. 5. The incident report form, witness statement form, and authorization for medical treatment and work status forms are (blank) documents.
  4. 7. The EHS representative will identify any (blank) from the investigation.
  5. 9. Injured employees are responsible for completing (blank) sections on the new incident report forms.