Get the free First Report of Injury Workers Compensation Division

Reset First Report of Injury Minnesota Department of Labor and Industry Workers Compensation Division 443 Lafayette Road North St. Paul, MN 551554305 ×651× 2845030 See Instructions on Reverse Side

How to fill out first report of injury

How to fill out the first report of injury:

1. Gather all relevant information: Start by collecting all the necessary details about the injured person, including their full name, contact information, and job title. Also, note down the date, time, and location of the injury.
2. Provide a description of the incident: Write a clear and concise narrative of what happened, describing the circumstances leading to the injury. Include information such as the activities being performed at the time, any equipment involved, and any witnesses present.
3. Document the injury details: Describe the nature and extent of the injury in detail. Include the body part affected, the type of injury (e.g., laceration, sprain, fracture), and any immediate treatment provided, such as first aid.
4. Record any contributing factors: Identify any factors that may have contributed to the injury, such as unsafe working conditions, inadequate training, or equipment malfunction. This information will help identify areas for improvement in preventing future incidents.
5. Obtain witness statements: If there were witnesses to the injury, try to gather statements from them. Include their names, contact information, and a summary of what they witnessed. Their perspectives can provide additional insights into the incident.
6. Seek medical attention: Advise the injured person to seek appropriate medical attention for their injuries. Include details about the medical facilities or professionals involved in treating the injury.
7. Review and submit the report: Go through the report carefully to ensure all information is accurate and complete. Seek assistance from your supervisor or a designated safety officer if needed. Once reviewed, submit the report to the appropriate department or person responsible for handling workplace injuries.

Who needs the first report of injury?

The first report of injury is typically required by employers or organizations to document and report workplace injuries. This report serves several purposes, such as:

1. Reporting to regulatory authorities: Many jurisdictions have legal requirements for employers to report certain types of workplace injuries to government agencies. The first report of injury helps fulfill this obligation.
2. Insurance purposes: The report is often necessary for filing workers' compensation claims. Insurance providers need this information to assess the validity of the claim and provide appropriate compensation or benefits.
3. Internal tracking and analysis: Keeping a record of workplace injuries helps organizations identify patterns, trends, or recurring issues. This data assists in implementing preventive measures, improving safety protocols, and reducing the likelihood of future incidents.
4. Compliance and legal purposes: Documentation of workplace injuries aids in complying with laws and regulations related to occupational health and safety. It also provides evidence in case of legal disputes or investigations related to the incident.

Therefore, employers, human resources departments, safety officers, insurance providers, and regulatory authorities typically require the first report of injury.

For pdfFiller’s FAQs

What is first report of injury?

First report of injury is a document used to report a workplace injury or illness.

Who is required to file first report of injury?

Employer is usually required to file the first report of injury.

How to fill out first report of injury?

You can fill out the first report of injury by providing details of the injury or illness, as well as information about the employee and the workplace.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document and report workplace injuries or illnesses for record-keeping and compliance purposes.

What information must be reported on first report of injury?

Information such as the date and time of the injury, the nature of the injury, and the name of the injured employee must be reported on the first report of injury.

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