Get the free First Report of Injury - Augusta County Public Schools

First Report of Injury Virginia Workers Compensation Commission 1000 DMV Drive Richmond Virginia 23220 1-877-664-2566 Reason for filing: VOC Jurisdiction Claim #: (If assigned) SEE INSTRUCTIONS ON

How to fill out first report of injury

How to fill out first report of injury:

1. Obtain the necessary forms: Gather the first report of injury form from your employer or workers' compensation insurance carrier. Make sure you have all the required paperwork before proceeding further.
2. Accurately provide personal information: Begin by filling out your personal details, including your full name, contact information, social security number, and date of birth. Ensure that all this information is accurate and up to date.
3. Provide employment details: Provide information about your employment, such as your job title, department, and the date of the injury. Include the specific location and time of the incident as well.
4. Describe the injury: In a clear and concise manner, describe the nature of your injury or illness. Include details such as how it happened, the symptoms you experienced, and any specific body parts affected. Be as specific as possible to help ensure accurate treatment and compensation.
5. Report witnesses: If there were any witnesses to the incident, provide their names and contact information. Their statements might be valuable in supporting your case and providing additional evidence.
6. Seek medical attention: Indicate whether you sought immediate medical attention after the injury and provide the name and contact details of the healthcare provider who treated you. It's crucial to seek medical attention promptly, as delays may affect your compensation claim.
7. Provide details of prior injuries: If you have previously suffered similar injuries or have any pre-existing conditions that may be relevant, disclose this information honestly. Failing to report previous injuries may jeopardize your claim.
8. Sign and date the form: Once you have completed all the required sections, review the information for accuracy and sign and date the form. Your signature confirms that the information provided is true to the best of your knowledge.

Who needs the first report of injury:

1. Employers: The first report of injury is essential for employers as it helps them document workplace incidents and fulfill their legal and regulatory obligations. It allows them to stay informed about any injuries or illnesses that occur within their workforce.
2. Employees: Employees who sustain work-related injuries or illnesses need to fill out the first report of injury to initiate the workers' compensation claim process. It serves as a formal record of the incident and allows them to seek appropriate medical treatment and potential compensation for their injuries.

For pdfFiller’s FAQs

What is first report of injury?

The first report of injury is a form used to report an employee's injury or illness that occurred during the course of employment.

Who is required to file first report of injury?

Employers are typically required to file the first report of injury with their state's workers' compensation agency.

How to fill out first report of injury?

To fill out the first report of injury, employers must provide details about the employee, 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 ensure that employees receive the necessary medical treatment and that employers comply with workers' compensation laws.

What information must be reported on first report of injury?

Information such as the employee's name, date of injury, nature of injury, and how the injury occurred must be reported on the first report of injury.

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