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AG413 (09/12) Texas A&M Airline Administrative Services Human Resources WORKERS COMPENSATION INJURY REPORT LOG (To be maintained by unit as a permanent record in compliance with the Texas Workers

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How to fill out workers compensation injury report

How to Fill Out Workers Compensation Injury Report:

01

Begin by providing your personal information, including your full name, contact information, and job title.

02

Specify the date and time of the injury or the beginning of symptoms. Be as accurate as possible to ensure proper documentation.

03

Describe the circumstances leading to the injury or the cause of the symptoms. Provide a detailed account of what happened and where it occurred.

04

Indicate any witnesses present at the time of the incident. Include their names and contact information if available. Their statements may be valuable during the claims process.

05

Document any injuries sustained or symptoms experienced. Include specific details such as the affected body part(s), the severity of the injury or symptoms, and any immediate treatment received.

06

If you sought medical attention, provide the name of the medical professional or facility you visited. Include dates and details of the treatment received.

07

Attach any supporting documents such as medical bills, prescriptions, or diagnostic test results that relate to your injury or symptoms.

08

Sign and date the workers compensation injury report, ensuring that all information provided is true and accurate to the best of your knowledge.

Who Needs Workers Compensation Injury Report:

01

Employees who have suffered a work-related injury or developed occupational illnesses need to complete a workers compensation injury report. This report serves as an official document to initiate the claims process.

02

Employers require employees to fill out this report to fulfill their legal obligations and to provide accurate information about workplace incidents.

03

Insurance companies handling workers compensation claims utilize these reports to assess the validity of the claim and determine appropriate compensation.

Note: It is essential to consult with your employer's workers compensation guidelines and procedures to ensure you follow the correct protocol when filling out the injury report.

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What is workers compensation injury report?

Workers compensation injury report is a documentation of an injury or illness that occurred in the workplace and is used to report the incident to the employer and the workers compensation insurance carrier.

Who is required to file workers compensation injury report?

Employers are required to file workers compensation injury report when an employee is injured on the job.

How to fill out workers compensation injury report?

Workers compensation injury report can be filled out by providing details of the injury or illness, including date, time, location, and description of the incident.

What is the purpose of workers compensation injury report?

The purpose of workers compensation injury report is to ensure that injured employees receive proper medical treatment and compensation for their injuries.

What information must be reported on workers compensation injury report?

Information such as employee's name, date of birth, job title, date and time of injury, description of the injury/illness, and any medical treatment received must be reported on workers compensation injury report.

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