Workplace Injury Reporting

Workplace Injury Reporting

Your safety matters to us. This secure form allows employees to quickly report workplace injuries, incidents, or job-related illnesses so we can respond promptly and provide the appropriate support.

Please complete all applicable sections with accurate information. Timely reporting helps us:

• Coordinate medical care if needed
• Maintain proper workplace safety records
• Process workers’ compensation documentation efficiently
• Follow Michigan reporting requirements

All submitted information is handled with care and confidentiality.

For emergencies, please seek immediate medical attention or call 911.