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Supervisor's Injury Investigation

The Supervisor's Injury Investigation Report (PDF) should be completed by Supervisors immediately when a Caltech employee has a work-related injury or illness. The supervisor should conduct a thorough investigation and document as much information as possible, including witness statements if available. If you have reason to question the injury, please provide an explanation on a separate sheet of paper or contact the Disability & Leave Administration Unit.

The completed Injury Investigation Report should be returned to the Disability & Leave Administration Unit at Mail Code 168-84 within three (3) working days from the date of knowledge of the injury/illness.

Please Note:

  • The supervisor should always report the injury/illness to the Disability & Leave Administration Unit via telephone within 24 hours of knowledge of the injury/illness. The Supervisor's Injury Investigation Report should not replace the phoned in report.

  • Do not submit a Supervisor's Injury Investigation Report if no injury occurs.

If there are any questions, contact the Disability & Leave Administration Unit at (626) 395-4577 or (626) 395-8382.