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State of Rhode Island please check if correction of prior report employer#039’s first report of alleged occupational injury or disease DWC no. PO box 20190, Cranston, RI ...

How to fill out dwc 01 ri

How to fill out DWC 01 RI:

1. Obtain a copy of the DWC 01 RI form. It is available on the official website of the DWC (Division of Workers' Compensation).
2. Fill in the worker's name and contact information in the appropriate fields on the form. This includes their full name, address, phone number, and email address.
3. Provide the worker's date of birth and Social Security number in the designated spaces on the form. This information is essential for identification purposes.
4. Indicate the worker's occupation and job title in the relevant section. This helps provide context for their employment situation.
5. Next, enter the date of injury or onset of illness that the worker is claiming on the form. Be as accurate as possible to ensure the correct processing of the claim.
6. In the following section, describe the details of the injury or illness. Include information such as the body parts affected, how the incident occurred, and any available medical documentation related to the injury or illness.
7. Provide the name and contact information of the worker's employer. Include their company name, address, phone number, and any other relevant details.
8. If applicable, indicate whether the worker has already received medical treatment for the injury or illness. If so, provide details about the healthcare provider and any medical records that support the claim.
9. Lastly, the form requires the worker's signature and date. Make sure the worker signs the form before submission.

Who needs DWC 01 RI:

1. Employees who have experienced a work-related injury or illness and wish to file a workers' compensation claim.
2. Employers who are required to provide workers' compensation coverage for their employees.
3. Healthcare providers or medical professionals who are involved in the treatment or evaluation of work-related injuries or illnesses and need to document the necessary information for the claim.

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What is dwc 01 ri?

DWC 01 RI is a form used for reporting work-related injuries and illnesses to the relevant authorities.

Who is required to file dwc 01 ri?

Employers are required to file DWC 01 RI when an employee suffers a work-related injury or illness.

How to fill out dwc 01 ri?

To fill out DWC 01 RI, employers must provide information about the injured employee, the nature of the injury or illness, and details of the incident.

What is the purpose of dwc 01 ri?

The purpose of DWC 01 RI is to ensure that work-related injuries and illnesses are properly documented and reported for statistical and regulatory purposes.

What information must be reported on dwc 01 ri?

Information that must be reported on DWC 01 RI includes the employee's name, date of birth, date of injury/illness, nature of injury/illness, and details of the incident.