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First Report of Injury Minnesota Department of Labor and Industry Workers Compensation Division PO Box 64221 St. Paul, MN 551640221 (651) 2845032 or 18003425354 Fax: (651) 2845731 PRINT IN INK or

How to fill out first report of injury

How to fill out the first report of injury:

1. Start by gathering all the necessary information such as the injured person's name, contact details, and job title.
2. Note down the date and time of the injury, as well as the location where it occurred.
3. Describe the injury in detail, including the body parts affected and the nature of the injury (e.g., sprain, laceration).
4. Write down any contributing factors or causes of the injury, such as equipment failure or unsafe working conditions.
5. If there were any witnesses to the incident, collect their names and contact information for future reference.
6. Make sure to include any medical treatment provided to the injured person immediately following the incident, including the name of the medical professional or facility.
7. Include information about any previous injuries or medical conditions that might have been aggravated by the incident.
8. The person filling out the report should sign and date it, indicating their role or position within the organization.

Who needs the first report of injury?

1. Employers: It is crucial for employers to have a record of all workplace injuries to ensure proper investigation, provide necessary support to the injured person, and take steps to prevent similar incidents in the future.
2. Injured Person: The injured person needs a copy of the first report of injury for their own records and to submit it to insurance companies or other relevant parties, if necessary.
3. Insurance Companies: Insurance providers require the first report of injury to process claims and determine liability.
4. Government Authorities: Depending on local laws and regulations, government agencies may require employers to submit the first report of injury for compliance purposes.

Note: It is important to consult with local regulations and guidelines specific to your jurisdiction when filling out the first report of injury, as requirements may vary.

For pdfFiller’s FAQs

What is first report of injury?

The first report of injury is a form completed by the employer to report any work-related injuries or illnesses that occur to employees.

Who is required to file first report of injury?

Employers are required to file the first report of injury when an employee sustains a work-related injury or illness.

How to fill out first report of injury?

The first report of injury can typically be filled out online or on a paper form provided by the employer. It will require information about the employee, the injury or illness, and the circumstances surrounding it.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document and track work-related injuries and illnesses, ensure that employees receive necessary medical treatment, and prevent similar incidents in the future.

What information must be reported on first report of injury?

Information that must be reported on the first report of injury includes details about the employee, the injury or illness, the date and location of the incident, and any witnesses.

When is the deadline to file first report of injury in 2023?

The deadline to file the first report of injury in 2023 is typically within a certain number of days after the injury or illness occurs. It is important to check with your state's specific requirements.

What is the penalty for the late filing of first report of injury?

The penalty for late filing of the first report of injury can vary depending on the state, but it may result in fines or other consequences for the employer.

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