Employee must return a completed Incident Injury Report Packet to Human Resources. The packet includes 3 pages. The incident report must be completed by the employee. The second page must be signed by both the employee and supervisor. The third page must be completed and signed by the employee. Failure to complete the pages will cause a delay in processing and must be returned to the employee for signature.
(Images link to Incident Report Packet)
Contacts
First Report of Incident Injury Memo and Acknowledgment Form must be submitted to the following individuals by email:
To:
Training Manager (Currently: Elizabeth Saavedra)
Senior HR Support Specialist (Currently: Wendy Whipple)
CC:
Senior Employee Relations Specialist (Currently: Annette Williams)
Night or Day Shift Manager (Night - Andy Yanez, Day - Seyfi Yazicioglu)
Email Sample
- Subject: First Report of Incident Injury Memo and Network Acknowledgement Form for (employee name) – (Date of Injury 00/00/0000)
Related articles
The first two pages of the packet constitute the FRI. The last page is the AF. They are saved as separate documents in SharePoint and Common.
The FRI and AF do not need to be communicated verbally to the Training Manager.
WSR's with restrictions require Training Manager instructions on eligibility for a Modified Work Program.