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WORKERS COMPENSATION
EMPLOYEE NOTIFICATION
Workers Compensation is designed to provide wage loss benefits and reimbursement
for reasonable medical care for one who is injured on the job. Your employer
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How to fill out workers compensation employee notification
How to fill out workers compensation employee notification:
01
Start by gathering all relevant information about the incident: date, time, location, and a detailed description of how the injury or illness occurred.
02
Include your personal information, such as your full name, address, phone number, and email address.
03
Specify your job title and department within the company.
04
Indicate whether the injury/illness occurred on company premises or during work-related activities.
05
Provide the contact information of any witnesses who can testify to the incident.
06
Fill out the medical treatment section, including the date of treatment, healthcare provider's information, and a brief description of the medical services received.
07
If you missed work due to the injury/illness, disclose the dates of absence and the number of days you were unable to work.
08
Sign and date the form, acknowledging that the information provided is accurate to the best of your knowledge.
Who needs workers compensation employee notification:
01
Employees who have experienced a work-related injury or illness and require medical attention.
02
Individuals who have suffered an injury on company premises or during work-related activities and need to report it to their employer.
03
Workers who have missed work or are unable to perform their regular duties due to an injury or illness related to their job.
Note: It is important to consult with your employer's human resources department or workers' compensation coordinator for specific instructions on how to fill out the workers compensation employee notification form.
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