REPORTING A WORKPLACE ACCIDENT

It is each employee’s responsibility to notify his or her supervisor (If the supervisor is not onsite, the administrative assistant should be contacted and will initiate the process), immediately after an incident occurs regardless of how slight the injury may seem to be. Following the instructions on the Worker’s Compensation website and using the Worker’s compensation Incident Investigation Report , the Supervisor will investigate and document the work related injury. As detailed, the employee’s supervisor is responsible for initiating, investigating, recording and submitting the necessary information to the third party administrator Gallagher Bassett. Both front and back of this form are to be completed.

Please note: if the employee does not require medical assistance at this time the “NEAR MISS” box will be checked when completing the Worker’s Compensation Incident investigation Report. If medical attention was needed, it will be marked accordingly. When complete, the Supervisor will scan all to tnwclaims@tnwinc.com and Risk Management.