Tone Products Inc.
Workers' Compensation Incident Report
🏠
🌐 Español
📋
Incident Info
👤
Employee Info
📍
Location & Witnesses
🩺
Injury Description
✍️
Signatures & Submit
TYPE OF INCIDENT
⚠️ Injury
🤒 Illness
SUPERVISOR NAME
— Select Supervisor —
Carlos Delgado
Terrance Patton
Raymundo Garcia
Ramon Cancel
Vicente Ocampo
Gladimir Saquil
Jose Luis Hernandez
Jorge Talamantes
Maria Slayton
Other
DEPARTMENT
— Select Dept —
Production
QA
Sanitation
Maintenance
Office Staff
Other
BUILDING
— Select —
A
B
C
D
SHIFT
1st
2nd
3rd
DATE OF INCIDENT
📅
TIME OF INCIDENT
🕐
LAST DAY WORKED
📅
DID EMPLOYEE NOTIFY SUPERVISOR WHEN INCIDENT OCCURRED?
Yes
No
Next →