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DEPARTMENT OF LABOR WORKERS COMPENSATION DIVISION NATIONAL LIFE DRIVE, DRAWER 20 MONTPELIER, VT 05620-3401 (802) 828-2286 DOL Form 4 State File No.: Rev 5/05 Insurance Co. File No.: Date of Injury:

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What is report of fatal accident?

The report of fatal accident is a document that details the circumstances surrounding a fatal accident.

Who is required to file report of fatal accident?

Employers, businesses, or individuals who are responsible for the work site where the fatal accident occurred are required to file the report of fatal accident.

How to fill out report of fatal accident?

The report of fatal accident should be completed with detailed information about the incident, including the date, time, location, and cause of the accident.

What is the purpose of report of fatal accident?

The purpose of the report of fatal accident is to investigate the causes of the accident, prevent future incidents, and ensure compliance with safety regulations.

What information must be reported on report of fatal accident?

The report of fatal accident must include information about the deceased individual, the circumstances of the accident, any witnesses, and details about the work site.

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