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Director/Nurse Manager's Investigation Reporting Occupational Injury-Illness Mobile App

The Director/Nurse Manager's Investigation Reporting Occupational Injury-Illness mobile app allows hospitals, physicians and nurses to complete a medical Director/ Nurse Manager's Investigation Reporting Occupational Injury-Illness form using a Smartphone or Tablet. The app covers: date of injury, preventability, cause of injury, contributing factors, action plan and corrective recommendations. Use GoCanvas to Auto-Populate fields.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

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Take a peek inside the Director/Nurse Manager's Investigation Reporting Occupational Injury-Illness Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Priviledged and Confidential Information

  • Ico statictext

    ( Complete and forward to RISK MANAGEMENT no later than two weeks after the event )

  • Ico date

    DATE INJURY REPORT RECEIVED BY SUPERVISOR / DIRECTOR:

  • Ico dropdown

    WAS THIS A PREVENTABLE INJURY / ILLNESS?

  • Ico multiline

    IF "Yes", EXPLAIN HOW EVENT COULD HAVE BEEN PREVENTED:

  • Ico multiline

    CAUSE OF INJURY or ILLNESS (Elaborate):

  • Ico statictext

    CONTRIBUTING FACTORS TO THIS EVENT

  • Ico checkbox

    Under Staffing

  • Ico checkbox

    Equipment Related

  • Ico checkbox

    Personal Protective Equipment Not Use

  • Ico checkbox

    Wet Floor

  • Ico checkbox

    Weather Related

  • Ico checkbox

    Safety Practices Not Followed

  • Ico multiline

    (explain)

  • Ico checkbox

    Other

  • Ico textbox

    Other

  • Ico signature

    DIRECTOR / NURSE MANAGER'S SIGNATURE:

  • Ico date

    DATE:

  • Ico multiline

    RISK MANAGEMENT FOLLOW-UP AND RECOMMENDATIONS:

  • Ico dropdown

    ACTION PLAN: ( MUST be completed within two weeks )

  • Ico date

    DATE ACTION TAKEN

  • Ico date

    DATE ACTION COMPLETED

  • Ico multiline

    COMMENTS

  • Ico dropdown

    CORRECTIVE RECOMMENDATIONS:

  • Ico date

    DATE ACTION TAKEN

  • Ico date

    DATE ACTION COMPLETED

  • Ico multiline

    COMMENTS

  • ...and More!

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