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WYOMING REPORT OF INJURY Workers' Safety & Compensation 307-777-7441 Please use BLACK EMPLOYER INFORMATION CASE #: ink. Do not cross zeros or sevens. WORK COMP EMPLOYER # BUSINESS NAME ADDRESS CITY
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How to fill out wyoming report of injury
How to fill out Wyoming Report of Injury:
01
Obtain the necessary form: The Wyoming Report of Injury form can be obtained from your employer or workers' compensation office. You can also download it from their website.
02
Provide personal and employer information: Start by filling out your personal information, including your name, address, phone number, and Social Security number. Then, provide your employer's name, address, and contact information.
03
Describe the injury: Provide a detailed description of how the injury occurred, including the date, time, and location of the incident. Explain what task or activity you were performing when the injury happened.
04
Indicate the nature of the injury: Specify the body part or area affected by the injury. This can include any specific injuries, such as fractures, sprains, cuts, burns, or strains.
05
Include medical treatment details: Provide information about the medical treatment received for the injury. List the names of healthcare providers, hospitals, or clinics that have examined or treated you.
06
Describe the employer notification: Indicate how and when you notified your employer about the injury. Include the date and method of notification, as well as the name of the person you informed.
07
Include witness information: If there were any witnesses to the incident, provide their names and contact information. Witnesses can help validate your claim and provide additional information if needed.
08
Sign and date the form: Once you have completed all the required sections, sign and date the Wyoming Report of Injury form. Make sure to read the form thoroughly before signing to ensure accuracy and completeness.
Who needs Wyoming Report of Injury?
The Wyoming Report of Injury is needed by any worker who has suffered an injury or illness while on the job. This includes employees from all industries, including construction, manufacturing, healthcare, and office settings. It serves as a formal documentation of the incident and helps initiate the workers' compensation process for the injured worker. Employers also need the report to fulfill their legal obligations and provide necessary support to their employees following a work-related injury.
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What is wyoming report of injury?
The Wyoming Report of Injury is a form that must be filled out by employers to report any workplace injuries or illnesses that occur to their employees.
Who is required to file wyoming report of injury?
Employers in Wyoming are required to file the Report of Injury when an employee sustains a work-related injury or illness.
How to fill out wyoming report of injury?
The Report of Injury can be filled out online through the Wyoming Workers' Compensation Division website or by submitting a paper form to the division.
What is the purpose of wyoming report of injury?
The purpose of the Report of Injury is to ensure that employees receive the necessary medical treatment and benefits after a work-related injury or illness.
What information must be reported on wyoming report of injury?
The Report of Injury requires information about the employee, the injury or illness, the date and location of the incident, and any witnesses.
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