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EMPLOYER? S REPORT OF ACCIDENT DIVISION OF WORKERS COMPENSATION 800 SW JACKSON STE 600 TOPEKA KS 66612-1227 Submit Original Report only OSHA Case or File Number There is a ×250 penalties for repeated
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How to fill out employer39s report of accident
01
To fill out the employer's report of accident, start by gathering all relevant information about the accident, such as the date, time, and location it occurred.
02
Next, include details about the injured employee, such as their full name, job title, and contact information.
03
Describe the accident itself, providing a clear and concise account of what happened. Include any causes, contributing factors, or witnesses to the incident.
04
Document the injuries sustained by the employee, noting the body parts affected and the severity of the injuries.
05
If medical treatment was sought, provide details about the healthcare provider, the diagnosis, and any prescribed medications or therapies.
06
Indicate any work restrictions or lost time resulting from the accident, including the number of days or hours of work missed.
07
Additionally, provide information about any property damage or equipment involved in the accident, if applicable.
08
Sign and date the report, verifying its accuracy and completion.
Who needs the employer's report of accident?
01
Employers - It is essential for employers to maintain accurate records of accidents occurring in the workplace to comply with legal requirements and ensure the safety of their employees.
02
Employees - The injured employee and their representatives may need the report to ensure proper documentation of the accident and a smooth claims process for worker's compensation or other benefits.
03
Insurance companies - In the event of an insurance claim, insurance companies may require the employer's report of accident to assess liability and determine appropriate coverage.
04
Legal authorities - If investigations or legal proceedings arise from the accident, law enforcement agencies or legal authorities may need access to the employer's report for evidence and analysis.
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What is employer's report of accident?
Employer's report of accident is a document that must be filled out by the employer after an accident occurs in the workplace.
Who is required to file employer's report of accident?
The employer is required to file the employer's report of accident.
How to fill out employer's report of accident?
To fill out the employer's report of accident, the employer must provide detailed information about the accident, including the date, time, location, and description of the incident.
What is the purpose of employer's report of accident?
The purpose of the employer's report of accident is to gather essential information about workplace accidents for the purpose of monitoring and improving workplace safety.
What information must be reported on employer's report of accident?
The employer's report of accident must include information such as the names and contact details of the persons involved, a description of the accident, any injuries sustained, and any immediate action taken.
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