Get the free Employers’ Liability Accident Report Form

This form must be completed by the employer and returned to the Company immediately for processing claims related to workplace accidents involving employees.

How to fill out employers liability accident report

How to fill out Employers’ Liability Accident Report Form

1. Obtain the Employers' Liability Accident Report Form from your employer or their website.
2. Fill in the date and time of the incident at the top of the form.
3. Provide the name and contact information of the injured employee.
4. Describe the nature of the injury clearly and concisely.
5. Detail the circumstances surrounding the accident, including location and any witnesses.
6. Indicate any safety equipment that was being used at the time of the accident.
7. Sign and date the form once complete.
8. Submit the form to the designated person or department within your organization.

Who needs Employers’ Liability Accident Report Form?

1. Employers are required to fill out the Employers' Liability Accident Report Form whenever an employee has an accident that results in injury or loss.
2. Employees who are injured at work must ensure that a report is completed to facilitate claims and ensure proper documentation.

For pdfFiller’s FAQs

What is Employers’ Liability Accident Report Form?

The Employers’ Liability Accident Report Form is a document used by employers to report workplace accidents and injuries that occur to employees. It is a formal requirement in many jurisdictions and serves as a record for insurance and legal purposes.

Who is required to file Employers’ Liability Accident Report Form?

Employers who have employees covered under Employers' Liability Insurance are required to file the Employers’ Liability Accident Report Form whenever an employee is injured or becomes ill due to their work.

How to fill out Employers’ Liability Accident Report Form?

To fill out the Employers’ Liability Accident Report Form, provide details such as the date and time of the accident, description of the incident, information about the injured employee, medical treatment received, and any witnesses to the event. Ensure all sections of the form are completed accurately.

What is the purpose of Employers’ Liability Accident Report Form?

The purpose of the Employers’ Liability Accident Report Form is to document workplace accidents for legal and insurance purposes, ensure compliance with labor laws, and facilitate the claims process for any injuries or illnesses sustained by employees.

What information must be reported on Employers’ Liability Accident Report Form?

The information that must be reported on the Employers’ Liability Accident Report Form includes the date and time of the incident, details of the injured employee, description of the accident, medical treatment provided, and any witnesses' statements.