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FORM E ILLINOIS FORM 45: EMPLOYER IS FIRST REPORT OF INJURY Please type or print. Employer's VEIN Date of report Case or File # Is this a lost workday case? 127148252 Yes Employers's name No Doing

How to fill out first report of injury

To fill out the first report of injury, follow these steps:

1. Obtain the necessary forms: Contact your employer or insurance provider to obtain the first report of injury form. It may be available online or in paper format.
2. Provide personal information: Fill in your personal details such as your full name, address, contact number, and social security number. This information is vital for identifying the injured party.
3. Describe the injury: Clearly explain how the injury occurred, including the date, time, and location. Be specific about the nature of the injury and any body parts affected.
4. Include witness statements: If there were any witnesses present at the time of the injury, ask them to provide written statements detailing what they observed. Include their names, contact information, and signatures on the form.
5. Describe medical treatment received: Provide details about any medical treatment you have received for the injury, including the names of medical professionals or facilities involved. Include any medications prescribed or administered.
6. Document time off work: Indicate if you had to miss any work due to the injury. Specify the dates and duration of the absence, as well as any wages lost as a result.
7. Review and sign the form: Carefully review the completed form for accuracy and ensure all necessary fields are filled in. Sign and date the form before submitting it to your employer or insurance provider.

Who needs the first report of injury?

The first report of injury is required for various parties involved in the workers' compensation process. These may include:

1. Employers: Employers need this report to initiate the workers' compensation claim process and fulfill their obligations under the law.
2. Employees: Injured employees should fill out the report to formally document their workplace injury and begin the claims process to receive compensation and benefits.
3. Insurance providers: Insurance companies require the first report of injury to evaluate and process workers' compensation claims on behalf of the employer.
4. Legal representatives: Workers who seek legal representation for their workers' compensation case may need the first report of injury for their attorney to review and build their case.

Remember, the requirements for completing the first report of injury may vary depending on your jurisdiction and local regulations, so it's essential to consult with your employer or legal advisor for specific instructions.

For pdfFiller’s FAQs

What is first report of injury?

The first report of injury is a document that must be completed after 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 with their state's workers' compensation board.

How to fill out first report of injury?

The first report of injury should be filled out accurately and completely, including details of the incident and the employee's injuries.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document workplace injuries and ensure that employees receive proper medical treatment and compensation.

What information must be reported on first report of injury?

The first report of injury must include details of the incident, the nature of the employee's injuries, and any medical treatment received.

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