Douglas County Georgia

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Risk and Safety: Reporting Forms

Contact: Matt LaVerne - Director
Risk Management, Safety Management, Loss Prevention

8700 Hospital Drive - Douglas County Courthouse, 1st floor
Douglasville, Georgia 30134
Phone: 770-920-7294 - Fax: 770-920-7371

All workplace accidents, near misses, losses, property damage, and unusual events must be reported to the Office of Risk & Safety within 24 hours or the next business day with the appropriate reporting form, available in PDF format below.

ORS-1Work Comp 1st report of Injury
ORS-2Incident Report
ORS-3Motorist Call in Report
ORS-4Citizen Report Form - Form is Under Re-Construction
ORS-5Vehicle CRASH Report & Supervisor Analysis
ORS-6Property Loss and Damage Report
ORS-7Supplemental Narrative Form
ORS-8Employee Safety Citation
ORS-9Safety Suggestion Form
ORS-10Medical Travel Reimbursement Form
ORS-11Employee Declination Form
ORS-12MVR Consent Form
ORS-13Driver Orientation Form
ORS-14Motor Vehicle Crash Worksheet
ORS-15Vehicle Crash Corrective Action Table

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