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MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS DIVISION OF WORKERS COMPENSATION REPORT OF INJURY P.O. BOX 58 JEFFERSON CITY, MO 651020058 (To complete form, see attached instructions) EMPLOYER
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How to fill out report of injury
How to fill out a report of injury:
01
Begin by providing your personal information, such as your name, contact information, and job title. This will help identify you as the injured party.
02
Specify the date and time of the incident. Be as accurate as possible to ensure the report reflects the correct timeline of events.
03
Describe the nature of the injury in detail. Include information such as the body part affected, the severity of the injury, and any additional factors that may have contributed to the incident.
04
Provide a clear and concise account of how the injury occurred. Include any relevant details, such as the location, equipment involved, or actions taken prior to the incident.
05
Document any witnesses present during the accident. Their contact information and statements can support your report and further investigations if necessary.
06
If applicable, list any safety measures that were in place at the time of the incident and whether they were adhered to or if there were any lapses.
07
Outline any immediate actions taken after the injury, such as seeking medical attention, notifying a supervisor, or filling out additional forms required by your employer.
08
Attach any medical records, photographs, or other supporting documents that may validate your injury and its impact.
09
Once you have completed the report, review it for accuracy and clarity. Ensure all necessary sections are filled out, and make any necessary edits before submitting it to the appropriate channels.
Who needs a report of injury:
01
Employers: A report of injury is required by employers to document workplace accidents and injuries. It helps them fulfill legal requirements, evaluate workplace safety measures, and initiate appropriate actions to prevent future incidents.
02
Injured Employee: Filling out a report of injury is crucial for the injured employee as it serves as an official record of the incident. It can be used to support workers' compensation claims, insurance processes, or legal proceedings if necessary.
03
Insurance Companies: Report of injuries provide insurance companies with details of workplace accidents and the resulting injuries. This information is crucial for determining liability, assessing compensation, and processing claims.
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What is report of injury?
Report of injury is a documentation outlining details of an incident in which a person is injured while on the job.
Who is required to file report of injury?
Employers are typically required to file a report of injury when an employee is injured on the job.
How to fill out report of injury?
To fill out a report of injury, one should provide detailed information about the incident, including date, time, location, description of the injury, and any witnesses.
What is the purpose of report of injury?
The purpose of a report of injury is to document the details of a workplace incident involving an injury, for record-keeping and potential legal purposes.
What information must be reported on report of injury?
Information that must be reported on a report of injury typically includes date, time, location, description of the injury, and any witnesses.
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