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Members may download one copy of our sample forms and templates for your personal use within your organization. Please note that all such forms and policies should be reviewed by your legal counsel for compliance with applicable law, and should be modified to suit your organization’s culture, industry, and practices. Neither members nor non-members may reproduce such samples in any other way (e.g., to republish in a book or use for a commercial purpose) without SHRM’s permission. To request permission for specific items, click on the “reuse permissions” button on the page where you find the item.
When an employee dies from a work-related incident or three or more employees are hospitalized as a result of a work-related incident, HR professionals must report it within eight hours. The HR representative must orally report the fatality or multiple hospitalizations by telephone or in person to the area office of the U.S. Occupational Safety and Health Administration nearest to the site of the incident. He or she may also use the toll-free central telephone number, (800) 321-6742. If the area office is closed, the HR representative should report the fatality or multiple-hospitalization incident using the 800 number.
Give the following information for each fatality or multiple-hospitalization incident:
If the HR representative does not learn of a reportable incident at the time it occurs, he or she must make the report within eight hours of the time the incident is reported to the HR representative or to any of the representative's agents or employees.
Source: U.S. Occupational Safety and Health Administration.
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