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Accident.Injury.Report
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					                                Accident/Injury Report

Complete immediately and forward to Human Resources within 24 Hours of Accident

Name of Injured Employee_________________________
ID# _________
Dept. ___________
Job Title __________________________
      Regular _____ Temporary _____ Agency ________
Injury Date _______________ Time ___________AM _____ PM _____
Date Reported ____________
Last day employee worked _________________ (If no time was lost, write “same”)
Date returned to work __________________
Supervisor _________________________         Reported by _____________________
Witnesses_____________________________________________________________
Where did injury occur (state location and building if multiple sites)? _____________
____________________________________________________________________
____________________________________________________________________
WHAT HAPPENED:
What was employee doing when accident occurred? ___________________________
_____________________________________________________________________
_______
_____________________________________________________________________
_______
How did accident occur?
_______________________________________________________
_____________________________________________________________________
_______
___
				
DOCUMENT INFO
Description: An accidental injury refers to an injury that results accidentally or from any external, violent and anticipated causes. Generally, the word "accident" and the word "injury" are not synonymous. Accidents occur without injury, and injuries occur without accident.
PARTNER William Glover
I received my B.B.A. from the University of Mississippi in 1973 and my J.D. from the University of Mississippi School of Law in 1976. I joined the firm of Wells Marble & Hurst in May 1976 as an Associate and became a Partner in 1979. While at Wells, I supervised all major real estate commercial loan transactions as well as major employment law cases. My practice also involved estate administration and general commercial law. I joined the faculty of Belhaven College, in Jackson, MS, in 1996 as Assistant Professor of Business Administration and College Attorney. While at Belhaven I taught Business Law and Business Ethics in the BBA and MBA programs; Judicial Process and Constitutional Law History for Political Science Department); and Sports Law for the Department of Sports Administration. I am now on the staff of US Legal Forms, Inc., and drafts forms, legal digests, and legal summaries. I am a LTC and was Staff Judge Advocate for the Mississippi State Guard from 2004-2008. I now serve as the Commanding Officer of the 220th MP BN at Camp McCain near Grenada, MS. I served on active duty during Hurricanes Dennis (July, 2005), Katrina (August, 2005) and Gustav in 2008. I played football at the University of Mississippi in 1969-1971 under Coach John Vaught. I am the author of the Sports Law Book (For Coaches and Administrators) and the Sports Law Handbook for Coaches and Administrators (with Legal Forms),