Complete this form and e-mail it to Chris Meyer, Manager - America's EHS (chris.meyer@manitowoc.com).
Include a copy of the JSA for the job or task the employee was performing at when they were injured with this notification. If a JSA does not exist for the job please indicate this in the JSA comment box (Cell B14).
Notification of lost time cases must be made the same day you become aware of them.
Notification of any other recordable must be made the same or next work day.
Provide as much information as is available to you at the time you are completing this form.
Do not delay sending this form beyond the timeframes listed above to gather additional information.
Documents from the formal incident investigation must also be e-mailed as soon as the investigation has been completed. The required documentation includes: Incident Investigation Report, injured employee and witness statements, root cause analysis tool, Systemic Failure Identification Form, and photographs).