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FIRST REPORT OF INJURY Worker To make a claim for a work related injury or illness, fill out the worker portion of this form and give it to your employer. If you do not intend to file a workers' compensation

How to fill out first report of injury

How to fill out first report of injury:

1. Start by gathering all necessary information about the injured person, such as their name, contact information, and job title.
2. Provide details about the injury, including the date and time it occurred, the location of the incident, and a description of what happened.
3. Indicate the severity of the injury and whether medical treatment was required. Include any information about the healthcare provider or facility that treated the injured person.
4. Document any witnesses to the incident and their contact information. Their statements may be valuable in verifying the details of the injury.
5. If applicable, note any equipment, machinery, or environmental factors that may have contributed to the injury.
6. Lastly, sign and date the report, indicating that the information provided is accurate to the best of your knowledge.

Who needs the first report of injury:

1. Employers: The first report of injury is essential for employers to document and investigate workplace accidents. It helps them assess safety hazards, implement preventive measures, and address any potential legal or insurance issues.
2. Employees: Filling out the first report of injury allows employees to report incidents and detail their injuries accurately. It ensures that any necessary medical treatment or workers' compensation claims can be initiated promptly.
3. Insurance Companies: Insurance companies require the first report of injury to process workers' compensation claims and determine the appropriate coverage for the injured employee.
4. Regulatory Bodies: In some jurisdictions, regulatory bodies responsible for workplace safety and health may require employers to submit the first report of injury for record-keeping and statistical purposes. This information helps in identifying trends and developing preventive strategies.

For pdfFiller’s FAQs

What is first report of injury?

The first report of injury is a form that employers must fill out and submit to their workers' compensation insurance carrier when an employee is injured on the job.

Who is required to file first report of injury?

Employers are required to file the first report of injury when an employee is injured on the job.

How to fill out first report of injury?

Employers must provide details about the injured employee, the nature of the injury, and how it occurred on the first report of injury form.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document and report workplace injuries in order to initiate the workers' compensation process.

What information must be reported on first report of injury?

Information such as the employee's name, date of injury, location of injury, description of injury, and any medical treatment received must be reported on the first report of injury.

How can I get first report of injury?

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