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RECEIVED BY CLAIMS-HANDLING ENTITY FIRST REPORT OF INJURY OR ILLNESS SENT TO DIVISION DATE DIVISION RECEIVED DATE FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION For assistance

How to fill out first report of injury

How to fill out first report of injury:

1. Obtain the necessary forms: Begin by acquiring the first report of injury forms from your employer or insurance company. These forms are typically available online or through the HR department.
2. Provide personal information: Fill in your personal details such as name, address, contact number, and employee identification number. This information will help identify you and ensure accurate record-keeping.
3. Describe the incident: Clearly and concisely explain how the injury or accident occurred. Include the date, time, and location of the incident, as well as any contributing factors or witnesses present.
4. Document the injury details: Describe the nature of your injury or condition sustained as a result of the accident. Include as much detail as possible, such as the body part affected, the severity of the injury, and any initial medical treatments received.
5. Explain the situation to your supervisor: Your first report of injury may require you to provide information about whether you notified your supervisor or any other relevant personnel about the incident. If you haven't done so already, state why and when you plan to inform them.
6. Include medical treatment information: Provide details about any medical treatment you have received for the injury. This may include visits to doctors, hospitals, or specialists, as well as any prescribed medications or recommended future treatment.
7. Sign and date the form: Once you have completed all the necessary sections, review the information for accuracy and sign and date the form. By signing, you confirm that the information provided is true and accurate to the best of your knowledge.

Who needs first report of injury:

1. Employers: Employers need the first report of injury in order to initiate the workers' compensation process and assess whether the injury is work-related. This information helps employers track workplace safety and make any necessary improvements to prevent future incidents.
2. Insurance companies: Insurance companies require the first report of injury to evaluate the claim for compensation. They use this information to determine the extent of the injury, assess liability, and approve or deny the claim based on their policies and guidelines.
3. Employee: Employees need to fill out the first report of injury to ensure proper documentation of the incident and initiate the workers' compensation process. By submitting this report, employees can access medical treatment, rehabilitation services, and potential compensation for lost wages during their recovery period.

For pdfFiller’s FAQs

What is first report of injury?

The first report of injury is a form that is used to report workplace injuries or illnesses that occur to an employee during the course of their employment.

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?

The first report of injury must be filled out completely and accurately, including information about the employee, the injury, and the circumstances surrounding the incident.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document workplace injuries and illnesses, provide information for workers' compensation claims, and prevent future incidents from occurring.

What information must be reported on first report of injury?

Information that must be reported on the first report of injury includes the employee's name, date of birth, job title, date and time of injury, description of injury, and how the injury occurred.

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