All employers under ADOSH jurisdiction are required to notify ADOSH when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. ADOSH has jurisdiction over all private and public-sector employees in Arizona, excluding mining operations, Indian Reservations, and federal employees.
- A fatality must be reported within 8 hours.
- An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.
TO MAKE A REPORT
- Call ADOSH toll free at (855) 268-5251 or (602) 542-5795 (Phoenix) or (520) 628-5478 (Tucson).
- Use this form to report online. This form must be completed in its entirety. Failure to do so may cause a delay in processing. Be prepared to supply the business name, names of affected employees, location and time of the incident, brief description of the incident, contact person and phone number.
UNDER WHAT CIRCUMSTANCES AM I NOT REQUIRED TO REPORT AN INCIDENT?
Employers do NOT have to report an event if it: Resulted from a motor vehicle accident on a public street or highway (except in a construction work zone); occurred on a commercial or public transportation system, such as light rail, airplane or bus; involved hospitalization for diagnostic testing or observation only.
WHAT IF THE FATALITY, IN-PATIENT HOSPITALIZATION, AMPUTATION, OR LOSS OF AN EYE DOES NOT OCCUR DURING OR RIGHT AFTER THE WORK-RELATED INCIDENT?
If a fatality occurs within 30 days of the work-related incident, or if an in-patient hospitalization, amputation, or loss of an eye occurs within 24 hours of the work-related incident, then you must report the event to ADOSH.
WHO SHOULD REPORT A FATALITY OR IN-PATIENT HOSPITALIZATION OF A TEMPORARY WORKER?
Similar to the requirements for recording injuries and illnesses under 29 CFR Part 1904.31, the employer under ADOSH jurisdiction that provides the day-to-day supervision of the worker must report to ADOSH any work-related incident resulting in a fatality, in-patient hospitalization, amputation or loss of an eye.
HOW DOES ADOSH DEFINE “AMPUTATION?"
An amputation is the traumatic loss of all or part of a limb or other external body part. This would include fingertip amputations with or without bone loss; medical amputations resulting from irreparable damage; and amputations of body parts that have since been reattached. If and when there is a health care professional's diagnosis available, the employer should rely on that diagnosis.
HOW DOES ADOSH DEFINE "IN-PATIENT HOSPITALIZATION?"
ADOSH defines in-patient hospitalization as a formal admission to the in-patient service of a hospital or clinic for care or treatment. Treatment in an Emergency Room only is not reportable.
WHO IS REQUIRED TO REPORT?
All employers under ADOSH jurisdiction must report these incidents to ADOSH, even employers who are exempt from routinely keeping ADOSH records due to company size or industry.
Employers do NOT have to report an event if it: Resulted from a motor vehicle accident on a public street or highway (except in a construction work zone); occurred on a commercial or public transportation system, such as light rail, airplane or bus; involved hospitalization for diagnostic testing or observation only.
If a fatality occurs within 30 days of the work-related incident, or if an in-patient hospitalization, amputation, or loss of an eye occurs within 24 hours of the work-related incident, then you must report the event to ADOSH.
Similar to the requirements for recording injuries and illnesses under 29 CFR Part 1904.31, the employer under ADOSH jurisdiction that provides the day-to-day supervision of the worker must report to ADOSH any work-related incident resulting in a fatality, in-patient hospitalization, amputation or loss of an eye.
An amputation is the traumatic loss of all or part of a limb or other external body part. This would include fingertip amputations with or without bone loss; medical amputations resulting from irreparable damage; and amputations of body parts that have since been reattached. If and when there is a health care professional's diagnosis available, the employer should rely on that diagnosis.
ADOSH defines in-patient hospitalization as a formal admission to the in-patient service of a hospital or clinic for care or treatment. Treatment in an Emergency Room only is not reportable.
All employers under ADOSH jurisdiction must report these incidents to ADOSH, even employers who are exempt from routinely keeping ADOSH records due to company size or industry.