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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 Wyoming Report of Injury form from the Wyoming Workers' Safety and Compensation Division website or your employer.
02
Provide your personal information, including your full name, address, date of birth, and contact details.
03
Fill in your employer's information, such as their name, address, and contact details.
04
Specify the date and time of your injury or illness.
05
Describe in detail how the injury or illness occurred, including the location, cause, and any parties involved.
06
Indicate the body parts affected by the injury or illness and provide specific details about the injuries sustained.
07
If there were witnesses to the incident, include their names and contact information.
08
Specify whether you sought medical treatment and provide the details of the healthcare provider or facility.
09
Include any additional information or documentation related to the injury or illness, such as medical reports or photographs.
10
Sign and date the form to certify the accuracy of the provided information.
Who needs Wyoming Report of Injury:
01
Employees who have suffered a work-related injury or illness in Wyoming are required to complete the Wyoming Report of Injury.
02
Employers in Wyoming are obligated to have their employees fill out the report to ensure proper documentation and timely reporting of workplace injuries or illnesses.
03
The Wyoming Report of Injury is also important for insurance purposes, as it helps determine eligibility for workers' compensation benefits and provides a record of the incident for future reference.
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What is wyoming report of injury?
The Wyoming Report of Injury is a form that employers in Wyoming are required to file when an employee experiences a work-related injury or illness.
Who is required to file wyoming report of injury?
Employers in Wyoming are required to file the Wyoming Report of Injury when an employee experiences a work-related injury or illness.
How to fill out wyoming report of injury?
To fill out the Wyoming Report of Injury, employers need to provide information about the injured employee, including their name, address, and Social Security number, as well as details about the work-related injury or illness.
What is the purpose of wyoming report of injury?
The purpose of the Wyoming Report of Injury is to document and report work-related injuries or illnesses, which helps ensure that employees receive the necessary medical treatment and that employers comply with workers' compensation regulations.
What information must be reported on wyoming report of injury?
The Wyoming Report of Injury requires employers to report information such as the employee's name, address, Social Security number, date of birth, date of injury or onset of illness, and details about the injury or illness itself.
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