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Fill and Sign the Employee Forms City of Wisconsin Rapids

Fill and Sign the Employee Forms City of Wisconsin Rapids

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Open the document and fill out all its fields.
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Accident/Injury ReportPage 1 of 2 Accident/Injury Report Complete immediately and forward to Human Resources within 24 Hours of Accident Name of Injured Employee ID# Dept. Job Title  Regular Temporary Agency Injury Date Time AM PM Date Reported Last day employee worked (If no time was lost, write “same”) Date returned to work Supervisor Reported by Witnesses Where did injury occur (state location and building if multiple sites)? WHAT HAPPENED : What was employee doing when accident occurred? How did accident occur? Did equipment malfunction? No Yes Explain: What unsafe acts or conditions contributed to this accident? MEDICAL: Describe the injury (for example, cut, strain, fracture, etc.): Accident/Injury ReportPage 2 of 2 Have medical services been given to the employee? No Yes If yes, list name and address of all doctors, hospitals, medics or other medical personnel consulted: If medical services were sought at a later date, explain: Please attach an additional sheet if more room is necessary.

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How to Sign a PDF on Android How to Sign a PDF on Android

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