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MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS REPORT OF INJURY P.O. Box 58 Jefferson City, MO 651020058 (To complete form, see attached instructions) EMPLOYER (NAME, ADDRESS, INCL ZIP CODE)

How to fill out report of injury

How to fill out a report of injury:

1. Begin by gathering all necessary information such as the date and time of the injury, the location, and a detailed description of what happened. It is important to be as specific and accurate as possible in this section.
2. Next, provide personal information about the injured party, including their full name, address, phone number, and any other relevant contact details. If the person injured is a minor, it is important to include the information of their parent or guardian as well.
3. In the report, provide details about the nature of the injury, such as the body part affected and any visible damage or symptoms. Include any medical treatment that has been administered or is ongoing.
4. If there were any witnesses present at the time of the injury, gather their contact information and include it in the report. The witness statements can provide additional support or verification of the incident.
5. It is important to include any relevant information about the scene or environment where the injury occurred. This may include details about any hazardous conditions, equipment involved, or any other factors that may have contributed to the incident.

Who needs a report of injury:

1. Employers: Employers are required by law to maintain records of workplace injuries and illnesses. The report of injury helps them track and monitor the safety of their workplace, identify potential hazards, and take measures to prevent future incidents.
2. Insurance Companies: Insurance companies usually require a report of injury to process any claims related to the incident. This document helps them assess the validity and severity of the injury and determine the appropriate compensation.
3. Medical Professionals: Doctors and healthcare providers may request a report of injury to better understand the circumstances surrounding a patient's injury. This information can aid in providing proper medical treatment and determining the course of action for the patient's recovery.
4. Legal Authorities: In some cases, law enforcement or legal professionals may require a report of injury as part of an investigation or legal proceedings. The report provides critical details about the incident that can be used as evidence or support claims.

In summary, filling out a report of injury requires gathering detailed information about the incident and the injured party. This document is essential for employers, insurance companies, medical professionals, and legal authorities to assess the situation, provide appropriate treatment, and ensure proper compensation or legal action if necessary.

For pdfFiller’s FAQs

What is report of injury?

Report of injury is a document that details any incidents or injuries that occur in the workplace.

Who is required to file report of injury?

Employers are required to file a report of injury for any workplace incidents that result in injury.

How to fill out report of injury?

Report of injury can be filled out by providing details of the incident, the injured party, and any witnesses.

What is the purpose of report of injury?

The purpose of report of injury is to document and track workplace incidents in order to improve safety measures and provide support to injured employees.

What information must be reported on report of injury?

Information that must be reported on a report of injury includes details of the incident, extent of injuries, and any contributing factors.

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