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Safety Director


Jim Powell
100 E. Main Street
Jonesborough, TN 37659
423-753-1857


If you have a Workman's Comp. claim, please print the forms below and fill them out entirely.
To download the forms click on the arrow beside each one.

Employer's First Report of Injury Form

Employee Accident Report

Supervisor's Accident Investigation Report

Request for Medical Care Report

Employee's Choice of Physician Report

Return to Work Form


Today, seat belts are an essential part of a vehicle safety system but as with any safety system, seat belt performance is dependant on proper use and fit. If the belt is not positioned correctly on the vehicle occupant's body, it can fail to provide adequate safety in the event of a collision or rapid deceleration.

Please remember that seat belt use is required when operating county vehicles. Follow these tips to ensure that your seat belts provide the safety you and your passengers deserve:

1. Always wear your seat-belt, and insist that your passengers do the same. One non-restrained passenger can seriously injure others in the vehicle.

2. Seat belts help prevent internal injuries by spreading the force of a collision across two of the human body's strongest areas: the pelvis & upper chest. to ensure the proper distribution of force, the lap belt should be positioned across the upper thighs, and the diagonal belt across the chest.

3. Never slip the diagonal belt behind your body. The lap belt alone cannot prevent you from being thrown forward or out of the vehicle. Use the lap belt at all times, as well. Without this restraint, your body would be thrown under the diagonal belt and into the dashboard or steering wheel.

4. Make sure your belt fits snugly against your body. If it is too loose, you can be injured by being thrown against the belt itself.

5. If your seat belts don't seem to operate correctly, or you cannot adequately adjust them, return the car to a dealership or qualified repair shop for assistance.

6. If your vehicle is fitted only with lap belts (pre-1974 models) contact a dealership for an upgrade to a three point harness. Aftermarker kits are available for many vehicle makes and models.



In 2003, 56 percent of passenger vehicle occupants killed in crashes were not wearing seat belts. Don't be a part of this growing statistic.

Buckle Up - Every Time

Information Obtained from Progressive Casualty Insurance Company.


Did you know that skin cancer is the most common form of cancer in the United States? More than 1 million new skin cancer cases are diagnosed each year.

Skin cancer can affect everyone although people with fair complexions may be of greater risk, people of all ages and ethnicities are susceptible. Therefore, it's important to take precautions against UV Rays and know the warning signs for skin cancer.

There are no safe UV Rays; UV cannot be seen or felt directly and is easily reflected off water, sand, and snow. Enjoy the warmth of the sun but take precautions to avoid skin cancer, premature aging, wrinkles, dark spots and cataracts by practicing some simple sun safety tips; adopt the following sun safety habits to assure you are protected from harmful UV Rays:

1. Generously apply sunscreen with an SPF of 15 or greater. Reapply at least every two hours and after swimming or sweating.
2. Wear protective clothing such as long sleeves, pants, wide rimmed hat and sunglasses with UV protection.
3. Seek shade when appropriate; remember the sun's rays are strongest between 10:00 AM and 4:00 PM.
4. Avoid tanning beds
5. Drink plenty of water
6. Practice Sun Safety every day, all year long!

ABC's of skin cancer detection (visible warning signs you should look for)
A. Asymmetry- one half unlike the other half
B. Border- irregular, scalloped, or poorly defined
C. Color- varied from one area to another in the same mole, shades of tan and brown, black, and sometimes white, red or blue.
D. Diameter- larger than 6mm (larger than a pencil eraser)
E. Elevation- the mole is raised above the surface and has an uneven surface.

***This information was compiled by the Safety Committee and Washington Co.-Johnson City Health Dept.
Please take time to read these valuable tips.

And remember...........

ALWAYS BE SAFE!!




Washington County, Tennessee - Email
Jonesborough Courthouse and J.C. Downtown Centre
P.O. Box 219 Jonesborough, TN 37659


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