Unfortunately accidents and incidents happen. When such events happen inside the store and someone is hurt, please be sure to make whatever initial contact that is necessary immediately – contact 911, non-emergency medical, a relative or spouse of the injured party, etc. Once the initial care for a person has been made and things begin to settle down, we need to completely fill out the Injury Report Form. A current blank document can be found by clicking on the blue Injury Report Form hypertext above.
Here’s a few things to remember when completing this document:
- Completely and as accurately as possible fill out the top portion of the form including: Injury Date, Injury Time, Injured Person’s Name (legal first and last name, please no nicknames), Address, Phone Number, Male/Female, Date of Birth. This information will be used in case of future contact, if there is a need to view camera footage, or any other pertinent communication.
- Fill in the Details of the Incident: It is important to stick to the facts and use as much plain language as possible. A good rule of thumb is to put as much detail as necessary to be able to understand what happened if someone else needed to read this after 3 months. So, please include information that would clearly indicate where it happened in the store, what happened, what measures were taken after the event (such as who was contacted) and what kind of resolution was met.
- Fill in the Description of the Injury: write in a brief description of the injury sustained.
- Fill in the Hospital/Physician information only if the injured person is taken to one. If the injury does not require medical assistance, write in “N/A” for “Not Applicable” on each line.
- Important Notes and Instructions should be filled in if there is need for follow up.
- Ask the injured person(s) to sign and date on the Injured Person/Party Signature line and fill in the date.
Upon completion of this document, it should be emailed to Jeff, Mark, Fran, Joe, Teri and Carolyn. Please keep an original copy at the store in the Human Resources filing cabinet.