Laborchex Companies




Sample Report - Workers' Compensation Check

[Investigation Description]

WORKERS' COMPENSATION CHECK

STATE SEARCHED: KY
STATUS: 2 Records Found

DATE OF INJURY: 7/12/2003RETURN DATE: 7/13/2003
EMPLOYER AWARE: YESDISABILITY DATE: 7/12/2003
INJURY TYPE: SCALDINGINJURY LOCATION: BACK OF LEFT HAND
EXTENT OF DISABILTIY: MINOR
INJURY SOURCE: STEAM OR HOT FLUIDSEMPLOYER NAME: BARRY'S SEAFOOD RESTAURANT
COUNTY: JACKSONWEEKLY WAGE: $785
COMMENTS: FILE#: 43483 9732 ACCIDENT DESCRIPTION: STIRRING BOILED SHRIMP IN POT, HOT WATER SPLASHED ON HAND.

DATE OF INJURY: 8/19/2003RETURN DATE: 8/29/2003
EMPLOYER AWARE: YESDISABILITY DATE: 8/19/2003
INJURY TYPE: BROKEN BONEINJURY LOCATION: LEG
EXTENT OF DISABILTIY: IMPAIRING
INJURY SOURCE: LADDER IN STOCKROOMEMPLOYER NAME: BARRY'S SEAFOOD RESTAURANT
COUNTY:JACKSONWEEKLY WAGE: $785
COMMENTS: FILE#: 43483 9745 ACCIDENT DESCRIPTION: WHILE CLIMBING LADDER IN STOCKROOM TO RETRIEVE BOX OF SPICES, EMPLOYEE FELL FROM LADDER AND FRACTURED FIBULA.