Report an Injury

Report a Workplace Injury

Use the form below to report a workplace injury. Please be as descriptive as possible.

The AdvanStaff HR safety and risk management team will be notified and will contact you shortly. A copy will be sent to you.

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Step 1 of 2

Type of care received:

Employee Name

Employee Email

Employee Phone

Employer Name:

Your Manager's / Supervisor's Name:

Has this incident been reported to your manager or supervisor?

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