Staffing Companies, Inc.

Temporary · Temp to Hire · Contract · Labor Management

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Charleston, SC

Houston, TX

Minneapolis, MN

Savannah, GA

ASSOCIATE FORMS

Injury Notification

STAFF FORMS

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2011 W2

PRIVACY POLICY

361846

5215000

Injury Notification


Call Now!

1-800-657-7022


Were you injured while working on assignment for StaffCo? 
If so, please complete the form on this page and we will contact you immediately.  Please remember that we must be notified of any on-the-job injuries immediately.  All on-the-job injuries or accidents require a post incident illegal substance screen.


First Name
Last Name
Social Security Number
Address Line 1
City
State
Zip Code
Daytime Phone() -
Evening Phone() -
E-mail Address
Today's Date
Date of Injury
Exact Time of Injury
Job Site Name
Type of Injury
How did the injury occur?
Did you contact the local branch?