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Claim No. Date Received in Compensation Of?CE CITY OF SPRINGFIELD (413) 787-6015 Notice of Accidental Injury/Occupational Disease Dept. Div. Last Name First Name MI Home Phone: Mailing Address: —

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What is notice of accidental injuryindd?

The notice of accidental injuryindd is a form that must be completed to report any accidental injuries that occur in the workplace.

Who is required to file notice of accidental injuryindd?

Employers are required to file the notice of accidental injuryindd when an accidental injury occurs in the workplace.

How to fill out notice of accidental injuryindd?

The notice of accidental injuryindd can be filled out online or in paper form, and must include details such as the date of the injury, the nature of the injury, and the name of the injured employee.

What is the purpose of notice of accidental injuryindd?

The purpose of the notice of accidental injuryindd is to ensure that all workplace injuries are properly reported and recorded for insurance and safety purposes.

What information must be reported on notice of accidental injuryindd?

The notice of accidental injuryindd must include information such as the date, time, and location of the injury, a description of the injury, and the names of any witnesses.

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