C.A.R.E. ILA Local 1975, Cleveland EMS union

On-Duty Injury

We encourage all members who suffer an on-duty injury to report the injury to their supervisor and follow the appropriate rules and regulations. At a later time, after you have obtained any needed medical treatment and a supervisor has completed the injury packet, please fill out the form below to help us better track on-duty injuries.

*We also ask that members fill out this form any time they treat a potential CoVID-19 patient to help us track these encounters

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On-Duty Injury form

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Name: *

E-mail address: *

Telephone/fax:

Date and time of injury *

Incident number (if available)

Working assignment at the time of the injury (e.g. Medic 30) *

Captain who filled out the injury packet. Alternatively, supervisor who states that an injury packet is "Not necessary." (Mandatory) *

Please describe the events surrounding the on-duty injury *

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Note: Fields marked with * are required

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