Get the free WKC-12-E Employers First Report of Injury or Disease

EMPLOYERS FIRST REPORT OF INJURY OR DISEASE Department of Workforce Development Fatal Injuries: Employers subject to ch.102, Wis. Stats., must report injuries resulting in death to the Workers Compensation

How to fill out wkc-12-e employers first report

How to fill out WKC-12-E employers first report:

1. Gather the necessary information: Before filling out the WKC-12-E employers first report, gather all relevant information, including the employee's name, address, social security number, and date of birth. Additionally, gather information about the accident or injury, such as the date and time it occurred, a detailed description of what happened, and any witnesses present.
2. Complete the employer information section: In the employer information section of the form, provide your company's name, address, and contact information. Ensure that all details are accurate and up to date.
3. Provide employee details: In the employee information section, fill in the employee's name, address, social security number, and date of birth. Double-check that the information is correct and matches the employee's records.
4. Describe the accident or injury: In the section for describing the accident or injury, provide a thorough and detailed account of what happened. Include specific details such as the date, time, location, and cause of the incident. Explain the nature and extent of the employee's injuries or damages.
5. Include witness information: If there were any witnesses to the accident or injury, provide their names, contact information, and a brief description of their account of the incident. This can help provide supporting evidence for the report.
6. Sign and date the form: Once you have completed all the necessary sections, sign and date the form to certify that the information provided is true and accurate.

Who needs WKC-12-E employers first report:

1. Employers: The WKC-12-E employers first report is primarily needed by employers. It is their responsibility to file this report with the relevant authorities in cases where an employee is injured on the job.
2. Workers' compensation agencies: Workers' compensation agencies require the submission of the WKC-12-E employers first report to evaluate and process claims for compensation. This report helps them determine the eligibility of the injured employee for benefits and assesses the employer's compliance with workers' compensation regulations.
3. Insurance providers: Insurance companies handling workers' compensation policies for employers may also require a copy of the WKC-12-E employers first report. This enables them to evaluate the claim and provide appropriate coverage or benefits to the injured employee.

Note: While the above groups primarily need the WKC-12-E employers first report, there may be additional entities, such as attorneys or legal representatives, who may request a copy of this report for litigation or other purposes.

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What is wkc-12-e employers first report?

The wkc-12-e employers first report is a form that needs to be filled out by employers to report workplace injuries and illnesses to the Workers' Compensation Board.

Who is required to file wkc-12-e employers first report?

Employers in certain industries are required to file the wkc-12-e employers first report, as mandated by state regulations.

How to fill out wkc-12-e employers first report?

The wkc-12-e employers first report can be filled out either online or through a paper form provided by the Workers' Compensation Board. Employers must accurately report all workplace injuries and illnesses.

What is the purpose of wkc-12-e employers first report?

The purpose of the wkc-12-e employers first report is to ensure that workplace injuries and illnesses are properly documented and reported for statistical and administrative purposes.

What information must be reported on wkc-12-e employers first report?

The wkc-12-e employers first report requires information such as the date of the incident, the nature of the injury or illness, and details of the affected employee.