{"id":272,"date":"2017-11-10T20:25:29","date_gmt":"2017-11-10T20:25:29","guid":{"rendered":"https:\/\/arssco.com\/?page_id=272"},"modified":"2017-11-10T21:22:25","modified_gmt":"2017-11-10T21:22:25","slug":"employee-report-injuryaccident","status":"publish","type":"page","link":"https:\/\/arssco.com\/?page_id=272","title":{"rendered":"Employee Report of Injury\/Accident"},"content":{"rendered":"<div class=\"breadcrumb\" itemprop=\"breadcrumb\"><span><span><a href=\"https:\/\/arssco.com\/\">Home<\/a><\/span><\/span><\/div>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f80-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"80\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F272#wpcf7-f80-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"80\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f80-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"one-half\">\n\t<p><label> Today's Date (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"todays-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"todays-date\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<div class=\"one-half last\">\n\t<p><label> Time (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"time\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"time\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<div class=\"one-half\">\n\t<p><label> Name (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"employee-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"employee-name\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<div class=\"one-half last\">\n\t<p><label> Date of Accident (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"accident-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"accident-date\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<p><label> Injury (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"injury\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"injury\" \/><\/span> <\/label>\n<\/p>\n<p><label> Treatment (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"treatment\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"treatment\" \/><\/span> <\/label>\n<\/p>\n<p><label> By Whom (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"by-whom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"by-whom\" \/><\/span> <\/label>\n<\/p>\n<p><label> Supervisor or Manager (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"by-whom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"by-whom\" \/><\/span> <\/label>\n<\/p>\n<p><label> Accident Description (What happened in your words) Who, What, When, Where, How, & Why? (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"accident-description\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"accident-description\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> In your opinion, what caused the Accident\/ Injury? (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"accident-cause\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"accident-cause\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Describe any unsafe conditions (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"unsafe-conditions\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"unsafe-conditions\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> I certify that the above information to be true and correct with no omissions (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"certify-true\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"certify-true[]\" value=\"I agree\" \/><span class=\"wpcf7-list-item-label\">I agree<\/span><\/span><\/span><\/span> <\/label>\n<\/p>\n<div class=\"one-half\">\n\t<p><label> Signature of Employee (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"signature\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"signature\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<div class=\"one-half last\">\n\t<p><label> Date (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-signed\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"date-signed\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<h2 style=\"text-align: center;\">Get in Touch With Us<\/h2>\n<p>Fill out the form below and click Send to contact us 24\/7. We&#8217;ll get back to you as soon as possible.<\/p>\n<p>\t<iframe loading=\"lazy\"\n  width=\"300\"\n  height=\"300\"\n  frameborder=\"0\" style=\"border:0\"\n  src=\"https:\/\/www.google.com\/maps\/embed\/v1\/place?key=AIzaSyBVJ4JR63d1JIL8L6b_emat-_jXMcHveR0&#038;q=24+North+%22D%22+Street+Fort+Smith%2C+Arkansas+72902+USA\" allowfullscreen><br \/>\n<\/iframe><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Get in Touch With Us Fill out the form below and click Send to contact us 24\/7. We&#8217;ll get back to you as soon as possible.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"class_list":["post-272","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Employee Report of Injury\/Accident - Arkansas Refrigerated Services<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/arssco.com\/?page_id=272\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Employee Report of Injury\/Accident - Arkansas Refrigerated Services\" \/>\n<meta property=\"og:description\" content=\"Get in Touch With Us Fill out the form below and click Send to contact us 24\/7. 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