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Injury & Accident Forms

Industry Safe – Reporting

In accordance with VRFA Operating Procedure 703, Accident, Injury and Property Loss Reporting, see the guidance below for reporting job related injuries/illnesses, vehicle accidents, and property damage.

It is the responsibility of staff to report any injury/illness, vehicle collision, or property damage incurred while performing their official duties. The reporting of such incidents shall be done immediately or as soon as practical to their immediate supervisor.

DO NOT delay medical treatment if necessary. If you believe, there was a risk of exposure follow exposure control plan and contact Exposure Control Officer.

After the supervisor is notified, the employee and supervisor will access the Industry Safe reporting database via the public web form: <<Click Here>>

The staff member needs to fill out the basic information module and attach any photos or memos. Be accurate and descriptive. The report shall be marked “In progress” under the incident analysis tab.

If an injury occurred, ensure the Company Nurse Injury Hotline is contacted with supervisor.

(1-888-770-0925) Use staff code – V030V

If seeking medical treatment, take WVFC Medical Release Form # to the physician to complete.

Turn in to the on-duty station office for clearance.

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