Accident Reporting Guide

CUSTOMER INJURY/CUSTOMER PROPERTY DAMAGE REPORTING

1.  Assess the situation- contact emergency services if needed

2.  Completely fill out the Customer Injury/General Liability Claim Reporting Form-do not give the form to the customer to complete. Include witness information and photos, if applicable.

3.  Call report into carrier- Nationwide Insurance 800-421-3535

4.  Enter claim number in the top right corner.

5.  FAX the completed EMPLOYEE INJURY REPORT form to

a.  Tampa: 813-200-1048

b.  Orlando/East Coast: 407-540-9629

6.  FOLLOW UP with a confirmation email to:

a.  Tampa:

b.  Orlando/East Coast :

7.  Customers may contact the Tampa Office at 813-877-7533 or Orlando Office at 407-332-7666 if they have further questions.

EMPLOYEE INJURIES / WORKERS’ COMPENSATION

1.  ASSESS THE SITUATION: Manager must assess the situation and handle appropriately; determine if employee needs medical attention

·  MOST injuries can and should be treated at your local urgent care walk-in facility. Please refer employees to approved doctors in your location for treatment. If you don’t know where this is: call the Tampa office.

·  If the injury is life threatening or requires immediate emergency treatment, the injured employee should go to the nearest emergency room.

2.  Locate the EMPLOYEE INJURY REPORT form on the Covelli webpage. Complete the form as soon as possible after the accident, even if you don’t have all the details yet.

3.  Call report into carrier- Zenith Insurance 800-440-5020

4.  Enter claim number in the top right corner.

5.  Take Pictures if needed able to and submit to HR Director.

6.  FAX the completed EMPLOYEE INJURY REPORT form to

a.  Tampa: 813-200-1048

b.  Orlando/East Coast: 407-540-9629

7.  FOLLOW UP with a confirmation email to:

a.  Tampa:

b.  Orlando/East Coast :

8.  Any medical bill, paperwork from the doctor, or other information received at the café should be submitted/faxed to your HR Director immediately.

Employee Accident Report Policy: Employees are to report any work-related injury immediately to your supervisor/manager.