Form ADOSH ICA2212 Serious Event Reporting Form - Arizona

What Is Form ADOSH ICA2212?

This is a legal form that was released by the Industrial Commission of Arizona - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form ADOSH ICA2212?
A: Form ADOSH ICA2212 is the Serious Event Reporting Form used in Arizona.

Q: What is its purpose?
A: The purpose of Form ADOSH ICA2212 is to report serious events that occur in the workplace.

Q: Who is required to use this form?
A: Employers in Arizona are required to use this form to report serious events.

Q: How do I obtain this form?
A: You can obtain Form ADOSH ICA2212 from the Arizona Division of Occupational Safety and Health (ADOSH).

Q: What kind of events need to be reported using this form?
A: Serious events such as fatalities, hospitalizations, and amputations need to be reported using this form.

Q: What information is required on the form?
A: The form requires information about the employer, the event, the individuals involved, and the actions taken to prevent future incidents.

Q: When should the form be submitted?
A: The form should be submitted within 24 hours of the serious event.

Q: Are there any penalties for not submitting the form?
A: Yes, failure to submit the form can result in penalties and citations from ADOSH.

Q: Is this form specific to Arizona?
A: Yes, Form ADOSH ICA2212 is specific to Arizona and is used for reporting serious events in the state.

Q: Is there a fee for submitting this form?
A: No, there is no fee for submitting Form ADOSH ICA2212.