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Injury / Incident Reporting
Incident Report Form
Once filled out and submitted it will automatically upload to the safety department, the fleet department and to you (or person filling it out). Once you receive the notification that the form was completed in your email you should forward it to you supervisor so they are aware of the situation.
4 Steps to remember during an injury or incident
1. Contact Field Safety Manager -After an incident, the employee must verbally contact their Field Safety Manager immediately. If the work-related injury is life, limb, or eyesight threatening, call 911 immediately.
2. Nurse 365 - After talking to your Field Safety Manager, the employee should contact Nurse 365 together with their supervisor to receive instructions for proper medical attention for injuries that are not life, limb, or eyesight threatening.
3. Incident reporting form - After verbal notification, gather the details of the incident, then fill out the Incident Reporting Form found on the AtwellSafe app.
*The supervisor is responsible for verifying Incident Reporting Form is completed and submitted.*
4. Drug and alcohol Screening - All employees involved in a major incident or work-related injury who require the care of a physician may be subject to a drug and alcohol screening.
5. Incident Contact Information:
- JJ Bland (Northeast): 304.627.8891
- Damone Gasaway (Midwest-West): 918.703.033
- Catfish (Southeast):850.851.8574
- Bill Oswald: 303.515.0071
6. Click here for the live Regional Safety Manager Map
Atwell Safety Team Only
The link below should be completed for each incident involving an Injury, MVA, or significant Near Miss.
