Get the free First Report of Injury or Illness

This form is used to report incidents of workplace injuries or illnesses, providing essential details required for workers' compensation claims processing in Florida.

How to fill out first report of injury

How to fill out First Report of Injury or Illness

1. Obtain a copy of the First Report of Injury or Illness form.
2. Fill in the employee's personal information, including name, address, and contact details.
3. Provide information about the employer, including business name and address.
4. Describe the incident, including the date, time, and location of the injury or illness.
5. Outline the details of the injury or illness, specifying the body part affected and the nature of the injury.
6. Include any witnesses' names and contact information, if available.
7. Document any immediate medical treatment received at the time of the incident.
8. Sign and date the form before submitting it to the appropriate personnel or department.

Who needs First Report of Injury or Illness?

1. Employees who have sustained work-related injuries or illnesses need to complete the First Report of Injury or Illness.
2. Employers or management must ensure the report is filled out for record-keeping and insurance purposes.
3. Health and safety officers may require the report to assess workplace safety and prevent future incidents.

People Also Ask about

What is it called when you get injured on the job?

Workers' compensation benefits are designed to provide you with the medical treatment you need to recover from your work related injury or illness, partially replace the wages you lose while you are recovering, and help you return to work.

What is it called when you get paid while injured?

Temporary disability (TD) benefits are payments you get if you lose wages because your injury prevents you from doing your usual job while recovering.

What is it called when an employee gets hurt on the job?

Workers' compensation benefits are designed to provide you with the medical treatment you need to recover from your work related injury or illness, partially replace the wages you lose while you are recovering, and help you return to work.

What is a first report of injury form?

The Employer's First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimant's employment and circumstances surrounding the injury or illness are also requested.

What is defined as a workplace injury?

The general rule is that all injuries and illnesses which result from events or exposures on the employer's premises are presumed to be work related. Furthermore, if it seems likely that an event or exposure in the work environment either caused or contributed to the case, the case is considered work related.

Why is it important to report the first signs of injury?

It allows for timely intervention by ergonomic or occupational professionals and prevention of potential hazards which greatly reduces the risk of injuries. By addressing reported symptoms early on, employers can implement measures to eliminate or minimize the risks, creating a safer work environment.

What is the definition of an injured employee?

"injured worker" means a worker who has received a workplace injury. "injury management" means the process that comprises activities and procedures that are undertaken or established for the purpose of achieving a timely, safe and durable return to work for workers following workplace injuries.

Which must be true for an employer to record an injury or illness?

How does OSHA define a recordable injury or illness? Any work-related fatality. Any work-related injury or illness that results in loss of consciousness, days away from work, restricted work, or transfer to another job.

For pdfFiller’s FAQs

What is First Report of Injury or Illness?

The First Report of Injury or Illness is a formal document that provides details about an employee's injury or illness that occurred in the workplace. It serves as an official notification to the employer and insurance carrier.

Who is required to file First Report of Injury or Illness?

Typically, the employer or the designated employee representative is required to file the First Report of Injury or Illness after being notified of the incident by the injured employee.

How to fill out First Report of Injury or Illness?

To fill out the First Report of Injury or Illness, the person responsible should gather all relevant details such as the employee's information, description of the incident, nature of the injury, and any witness information. The form must be filled out completely and accurately, ensuring all required fields are filled.

What is the purpose of First Report of Injury or Illness?

The purpose of the First Report of Injury or Illness is to document the occurrence of an injury or illness in the workplace, ensure prompt reporting to insurance carriers, and facilitate the claims process for workers' compensation.

What information must be reported on First Report of Injury or Illness?

The information that must be reported on the First Report of Injury or Illness includes the injured employee's name, job title, date and time of the incident, description of the circumstances surrounding the injury or illness, details of the injury or illness, and any witnesses.