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First Report of Injury Minnesota Department of Administration Workers Compensation PO Box 64081 St. Paul, MN 55164-0081 (651) 284-5030 1. EMPLOYEE SOCIAL SECURITY # 3. DATE OF CLAIMED INJURY 2. OSHA

How to fill out first report of injury

How to fill out first report of injury:

1. Gather necessary information: Start by gathering all the relevant information about the injured person, such as their full name, address, contact details, and job title. Additionally, note down the date and time of the injury, as well as the location where it occurred.
2. Describe the injury: Provide a detailed description of the injury sustained, including the body part affected and the nature of the injury (e.g., fracture, laceration). If there were any witnesses present, make sure to mention their names and contact information as well.
3. Report the cause: Clearly state how the injury occurred and provide any relevant details regarding the circumstances that led to it. This could involve a slip, fall, machinery malfunction, or any other contributing factor.
4. Include medical treatment details: Specify any medical treatment or first aid that was administered immediately following the injury. This could involve on-site first aid, transportation to a medical facility, or the involvement of emergency services.
5. Document lost time: If the injured person had to take time off work due to the injury, indicate the number of days they were unable to work. This will be important for any insurance or compensation claims.

Who needs first report of injury:

1. Employers: The employer is usually the primary recipient of the first report of injury. They need this information to ensure that proper safety measures are in place and to initiate any required actions, such as workers' compensation claims or reporting to regulatory authorities.
2. Insurance companies: Insurance providers, specifically those offering workers' compensation coverage, will require the first report of injury to initiate the claims process. This report helps them evaluate the validity of the claim and determine the appropriate course of action.
3. Regulatory agencies: Depending on the jurisdiction, there may be various regulatory agencies that require employers to report workplace injuries. These agencies use the first report of injury to monitor safety compliance, identify potential workplace hazards, and enforce regulations.
4. Healthcare professionals: In some cases, healthcare professionals may need access to the first report of injury to gain a better understanding of the circumstances surrounding the injury and provide appropriate medical treatment or advice.
5. Legal representatives: In situations where the injury results in legal action, such as personal injury lawsuits, the first report of injury becomes an essential document for attorneys representing either party. It helps them build a case and assess liability.

Remember, it is important to consult your organization's specific procedures and guidelines when filling out a first report of injury, as they may vary based on jurisdiction and industry regulations.

For pdfFiller’s FAQs

What is first report of injury?

The first report of injury is a form that details an employee's work-related injury or illness.

Who is required to file first report of injury?

Employers are required to file the first report of injury when an employee is injured or becomes ill due to work-related activities.

How to fill out first report of injury?

To fill out the first report of injury, the employer needs to provide details about the employee, the nature of the injury or illness, 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 work-related injuries or illnesses, provide information for insurance claims, and track workplace safety.

What information must be reported on first report of injury?

The first report of injury should include details about the employee, the injury or illness, the date and location of the incident, and any witnesses.

When is the deadline to file first report of injury in 2023?

The deadline to file the first report of injury in 2023 may vary by state or jurisdiction, so it is important to check with the relevant authorities.

What is the penalty for the late filing of first report of injury?

The penalty for the late filing of the first report of injury may include fines or other legal consequences, depending on the regulations in place.

How do I make changes in first report of injury?

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