Get and Sign illinois form 45

Hired Time employee began work Date and time of accident Last day employee worked AM PM If the employee died as a result of the accident give the date of death. Did the accident occur on the employer s premises Address of accident What was the employee doing when the accident occurred How did the accident occur What was the injury or illness List the part of body affected and explain how it was affected* What object or substance if any directly harmed the employee Name and address of...