Transcription of YOUR COMPANY NAME HERE WEEKLY INJURY REPORT - …
1 your COMPANY name here WEEKLY INJURY REPORT This REPORT is required to discover if any employee has been injured on the job since the last payroll period. If in fact you have been injured on the job during this time period, please complete a written REPORT complete with all the details of the accident, the time it occurred, where it took place and the nature of the INJURY . Pay Period : From To EMPLOYEE LAST name , FIRST name MI : Injured Not Injured Signature : EMPLOYEE LAST name , FIRST name MI : Injured Not Injured Signature : EMPLOYEE LAST name , FIRST name MI : Injured Not Injured Signature : EMPLOYEE LAST name , FIRST name MI : Injured Not Injured Signature : Sample text for Stickers to be signed by every employee each payroll period upon receiving their paycheck: Last name First name MI I was not injured on the job during this payroll period.
2 I was injured on the job during this payroll period. Signature Date Last name First name MI I was not injured on the job during this payroll period. I was injured on the job during this payroll period. Signature Date
