Employee Reports

Please scroll down and find the report you would like to use. You have the option to fill out an injury, incident, or an anonymous report. If you are reporting an injury, we must know your information & cannot be anonymous.

Injury Report

If you are injuried while working under United Employment Solutions, report the injury immediately after it happens. Do not wait to report.

Name *

First

Last

Email *

Last 4 of SSN

Please provide the last four numbers of your SSN so we may look you up in our system accurately.

Phone Number *

Please provide a phone number we can contact you with.

Date & Time The Injury Occurred *

Date

Time

The Site the Injury Occurred At *

Describe the Injury *

Please describe what injury occured and how it happened.

Submit

Incident Report

Name *

First

Last

Email *

Last 4 of SSN

Please provide the last four numbers of your SSN so we may look you up in our system accurately.

Phone Number *

Please provide a phone number we can contact you with.

Date & Time The Incident Occurred *

Date

Time

The Site the Incident Occurred At *

Describe the Injury *

Please describe what occurred and how it happened.

Submit

AnonymousReport

Please Describe What You Would Like To Report *

Where did the incident occur? *

Can we contact you for more details? *YesNo

Phone Number

Email

Submit