Get the free SUPPLEMENTAL REPORT OF INJURY, DWC Form-006 - Texas ... - tdi texas

Has the employer requested RTW training from DWC or the insurance .... website at: http://www.tdi.texas.gov/wc/rules.

How to fill out supplemental report of injury

How to fill out the supplemental report of injury:

1. Start by providing your personal information, such as your full name, contact information, and employee identification number.
2. Clearly state the date and time of the injury, along with the location where it occurred.
3. Describe in detail the nature of the injury, including the body part affected and any visible symptoms or conditions.
4. Provide information about any witnesses present at the time of the injury, including their names and contact information.
5. Indicate whether you received medical treatment for the injury and include the name of the healthcare provider or facility.
6. Include any relevant medical records or reports related to the injury, if available.
7. Describe any work restrictions or limitations resulting from the injury and how it may impact your ability to perform your job duties.
8. Submit the completed supplemental report of injury to the appropriate department or individual within your organization, as specified in your company's procedures or guidelines.

Who needs a supplemental report of injury:

1. Employees who have experienced a work-related injury or illness.
2. Employers who are required or choose to maintain accurate records of workplace injuries and illnesses.
3. Insurance providers or claims adjusters who need detailed information to assess and process workers' compensation claims.
4. Occupational safety and health agencies that monitor and enforce workplace safety regulations.

Overall, filling out a supplemental report of injury is essential for accurately documenting and reporting workplace injuries or illnesses. It helps ensure that appropriate medical care is provided, workers' compensation claims are properly processed, and necessary corrective measures are taken to prevent future incidents.

For pdfFiller’s FAQs

What is supplemental report of injury?

A supplemental report of injury is a report that provides additional information about an injury or illness that occurred in the workplace.

Who is required to file supplemental report of injury?

The employer or their representative is required to file a supplemental report of injury.

How to fill out supplemental report of injury?

To fill out a supplemental report of injury, you need to provide detailed information about the injury or illness, including the date, time, location, and description of the incident.

What is the purpose of supplemental report of injury?

The purpose of a supplemental report of injury is to gather additional information about an injury or illness in order to better understand and prevent workplace accidents and improve safety measures.

What information must be reported on supplemental report of injury?

The supplemental report of injury must include information such as the injured person's name, contact details, description of the incident, medical treatment received, and any witnesses.

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