Get the free FIRST REPORT OF INJURY - broomfieldorg
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Important: Please fax this report to HR (303) 4386328 within 24 hours of injury CITY AND COUNTY OF BROOMFIELD FIRST REPORT OF INJURY EMPLOYEE (INJURED WORKER) INFORMATION: Name (First, Middle Initial,
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How to fill out first report of injury
How to fill out the first report of injury:
01
Gather the necessary information: Start by collecting all the relevant details about the injury, such as the date and time it occurred, the location, and a detailed description of what happened.
02
Identify the parties involved: Determine who was injured and provide their personal information, including their name, address, and contact details. If there were any witnesses to the incident, make sure to include their information as well.
03
Provide employment details: Specify the injured person's job title, the department they work in, and their supervisor's name. Include information about any safety measures in place at the time of the incident.
04
Describe the injury: Explain the nature of the injury sustained, including the body part affected and the severity. If medical treatment was sought, provide details about the healthcare provider visited.
05
Document any time off work: If the injury resulted in the injured person taking time off work, indicate the dates and the expected duration of absence.
06
Include insurance information: If the injured person is covered by workers' compensation or any other insurance, provide the policy details and the contact information of the insurance company.
07
Sign and submit the report: Once all the required information has been filled out accurately, sign and date the report. Make copies for your records and submit the original to the appropriate authority or the HR department of your organization.
Who needs the first report of injury:
01
Employers: It is essential for employers to have a first report of injury on file for any workplace incident. This helps them ensure compliance with legal requirements and enables them to promptly address any necessary actions, such as conducting an investigation or implementing safety measures.
02
Injured employees: The first report of injury can serve as a record for employees who have suffered a workplace injury. It enables them to initiate the workers' compensation process or seek any necessary medical treatment.
03
Doctor or healthcare provider: The first report of injury provides medical professionals with crucial information about how the injury occurred and the related workplace conditions. This helps them provide the most appropriate and accurate treatment to the injured employee.
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What is first report of injury?
The first report of injury is a document that must be filled out and submitted when an employee is injured on the job.
Who is required to file first report of injury?
Employers are required to file the first report of injury when an employee is injured.
How to fill out first report of injury?
The first report of injury should be filled out accurately and completely, including details about the injury and how it occurred.
What is the purpose of first report of injury?
The purpose of the first report of injury is to document workplace injuries, track trends, and ensure that employees receive appropriate medical treatment and workers' compensation benefits.
What information must be reported on first report of injury?
The first report of injury must include details about the employee, the injury, how it occurred, and any medical treatment received.
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