Form 5020 online Clarksville Tennessee 2025

Form 5020 online Clarksville Tennessee: What You Should Know

This information may not be used except in connection with the employment relationship and any other application of laws, rules and regulations relating to health and safety. The person making the form understands and understands that failure to provide or obtain required information may result in the department taking action in accordance with any applicable law or regulation. This form is NOT authorized for use by or for the use of an employer with less than ten (10) full-time employees, other than their employees, representatives, or agents, who must complete and retain a form 5020 prior to hiring or transferring their work to this facility. A. GENERAL INFORMATION. The Department requires you to provide this information to our office in order to fulfill the requirements of the Occupational Safety and Health Act, and the Tennessee Workers' Compensation Act. You must provide this information either verbally at your work location or faxed to us at. B. THE INDIVIDUAL'S INJURY.  If the nature of your injuries or illnesses render you unfit for service due to physical disabilities or for other reasons, you must provide this information upon request. C. RESIDENT ANIMALS. You must document and complete the injury as if you were an animal as follows: If an animal injures, maims, or poisons you by biting, pouncing, seizing or injuring the skin with its teeth, or by any other means, you must report to the office within 7 days of becoming aware of the injury or sickness. If the animal does not injure you, but you are aware of an animal attack on you, you must report within 14 days of the incident. However, if the incident occurred during the week before your turn, you must report as soon as you are aware of the incident. D. SUSPENSION AND TERM OF CONTRACT. You must report to the office the reason why you have been terminated, suspended without pay, or terminated as from which you were suspended without pay. You must provide a written explanation of your reasons for the termination.

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