High School Diploma - Diploma
Waipahu
Waipahu, HI05.2014
Matthew Brame
Kailua Kona,HI
Education
Injury Reporting Instructions
- Report all injuries, no matter how small, immediately to:
- Your manager or supervisor AND
- HR Hawaii: 808-329-0121 or safety@hrhawaii.com
- Receive first aid if applicable &/or seek immediate medical treatment for all serious injuries.
- Complete the EMPLOYEE'S INJURY REPORT which you will receive from your supervisor or HRHI. If assistance is needed in completing the form, please ask your supervisor or HRHI as necessary.
- Supervisor will complete an ACCIDENT INVESTIGATION FORM.
- Send both the EMPLOYEE'S INJURY REPORT and the ACCIDENT INVESTIGATION FORM to safety@hrhawaii.com no later than 24 hours after the injury/incident occurs.
- Remember, if you require medical care, we can help you make the appointment with an appropriate physician listed on our medical provider list. NOTE: There are many doctors who do not accept workers compensation cases.
- If needed, a supervisor or appointed person will transport the injured worker to the doctor/hospital. Post-accident drug testing is mandatory, and timely reporting of workplace injuries are essential for this reason. All employees have authorized this procedure. You may give the doctor our information to confirm the drug testing, if necessary.
- If needed, your supervisor will notify your family of the injury. Please be sure all your information is current and up to date in case of an emergency. Contact our office if you need emergency contact information for your employee.
- Notify HRHI immediately of the following:
- When an accident occurs.
- If you are unable to return to work following the accident.
- When you return to work.
- Our Safety Director will reach out to follow-up on your incident, and initiate a Worker's Compensation claim if necessary.
Employee Injury Report
- Name of Injured Employee: ____________________________
- Address: ___________________________________________
- Telephone: __________________ Birth Date: _____________
- Occupation: ________________________________________
- Date and Time of Injury: ______________________________
- Date Injury Reported: ________________________________
- Name of Employer: ___________________________________
- Person Reported to: _________________________________
- Witness(es), if any: _________________________________
- Description of Injury (attach separate page with answers if necessary):
- A. If injury DID NOT occur on the job, describe how you got injured.
- B. What were you doing when you got injured?
- C. Object or substance that directly injured you?
- D. Describe in detail the nature of the injury and the part of the body affected.
- Disability Information:
- Did you complete your shift on the date of the incident? __________________
- Are you disabled or off work? __________ When did you become disabled? __________
- Who treated you (name and address)? ________________________________
- Who referred you to the Doctor? ____________________________________
- When did you first see your Doctor? __________ Any medical slip? __________
- EMPLOYEE'S SIGNATURE: __________________________ DATE: __________
- WITNESS' SIGNATURE: __________________________ DATE: __________
- SIGNATURE OF PERSON REPORTED TO: __________________ DATE: __________
- HR Hawaii, Inc. | hrhawaii.com
- 75-5591 Palani Rd. Ste. 3008 Kailua Kona, HI 96740
Timeline
High School Diploma - Diploma
Waipahu