Injury & Illness Investigation Report

In compliance with Title 8, Section 3203 of the California Code of Regulations all injuries must be investigated immediately. To comply with this standard we have established an Investigation Report to be filled out by the supervisor/Manager/Department Head or qualified investigator within 24 hours of the injury/illness to an employee. 

Once the investigation is performed and the report completed send the form within the 24 hour time period to EH&S via email, fax or scan.  If further investigation is required EH&S will contact you.

Severe Or Life Threatening Injury/Illness will be investigated by one or more of the following:

• EH&S
• Security
• Employee Health Services
• LLUHC Occupational Medicine Center
• LLUMC Emergency Department

Report

• Report an Injury

Disciplinary action forms

While preventing injury illness is the main focus as part of the IIPP program disciplinary action is a vital component. The verbal and written warning forms are for management use in documenting disciplinary corrective action when required.

• Verbal Warning Form
• Written Warning Form