Supervisor's First Report of Injury
Supervisor's First Report of Injury
First Priority: Health & Safety - For Serious Injuries Dial 911 Immediately!
- Immediately report all work related injuries to Kimberly Worlow (615) 390-9552.
- Following the notice of work-related injury please complete all necessary paperwork as follows:
- Employee Injury Report or Refusal Of Medical Care Form
- Medical Treatment Authorization Form (If applicable)
- Supervisor First Report of Injury.
- Assist the injured employee by locating the nearest Occupational Medical facility, to find a local medical facility visit https://talispoint.com/cvty/agcs. The injured worker MUST be sent to the medical facility with a completed medical authorization form.
- Final Step - Please upload Employee Injury Report or Refusal of Medical Care and any other relevant documents when submitting this form.
Supervisor's - please complete this form with as much detail as possible.
Thank you!