A&R Weekly Occupational Safety Log for Injuries

By signing my name below, I am stating to the best of my knowledge, I DID NOT HAVE AN ACCIDENT OR SUSTAIN AN INJURY AT WORK THIS PREVIOUS WEEK. My employer and I recognize there may be injuries that can occur and not be known to me immediately. If I suffer any injury, I will immediately report it to my employer upon becoming aware of it. By signing this form, I understand I am not prevented from reporting an accident or injury, or making a claim at a later time. However, I understand that any failure by me to promptly report an accident or injury will require me to explain why I did not follow the Prompt Reporting Policy.

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!

You are stating you WERE INJURED on the job his week. You must complete the "Employee Accident Report" and the accident investigation prior to leaving the job site. REPORT YOUR ACCIDENT/INJURY IMMEDIATELY TO YOUR FOREMAN OR THE SAFETY DEPARTMENT!!