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Arizona Employers Report of Industrial Injury

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Arizona Employers Report of Industrial Injury

FED2215

Arizona employers are required to report an industrial injury or illness within 10 days of an accident resulting in injury or illness and within 24 hours of an accident resulting in a fatality.

Whenever an employee is injured in the workplace in Arizona, the employer must complete the Employer’s Report of Industrial Injury in order to be compliant with OSHA reporting requirements. The Employer’s Report of Industrial Injury must be completed and mailed within 10 days from the employee’s notice of an incident that resulted in injury or illness. The report must be completed and mailed within 24 hours in the event of a fatality.

The form provides Arizona employers with fields in which they are required to describe the nature of the injury, illness, or fatality, circumstances surrounding the incident, and details about the employee’s condition. Employers are also required to provide information about the employee’s wages, expected date of return to work (if applicable), and loss of work.

Arizona employers are required to retain a copy of all submitted Employer’s Report of Industrial Injury forms for at least five years after an incident has occurred.

This package of Employer’s Report of Industrial Injury forms contains 25 forms that are fully compliant with federal OSHA reporting requirements and contain all of the necessary reporting fields that employers must complete in order to adequately report a workplace incident.

Product Specifications:

  • This form is 8.5" x 11"
  • 25 Sheets/Package

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$14.95

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