Get the free First Report of Injury Form - DHMH - Maryland.gov - dhmh maryland

INSTRUCTIONS COMPLETING EMPLOYEE FIRST REPORT OF INJURY 1. Employee or an individual acting on the employee's behalf completes the Employee First Report of Injury Form. 2. Supervisor or another responsible

How to fill out first report of injury

How to fill out the first report of injury:

1. Gather the necessary information: Before filling out the form, ensure that you have all the relevant details regarding the injury. This includes the date and time of the incident, location of the injury, nature of the injury, and any witnesses present.
2. Complete the employee information section: Begin by filling out the employee information section of the form. This typically includes the employee's full name, contact information, job title, and department.
3. Provide details of the injury: In the section dedicated to the injury, describe the incident in detail. Include information such as how and where the injury occurred, what the employee was doing at the time, and any contributing factors. Be as thorough and accurate as possible.
4. Include witness statements: If there were any witnesses to the incident, make sure to document their statements in the appropriate section. This adds credibility to the report and provides additional information that may be useful during the investigation.
5. Document medical treatment: If the employee sought medical attention for their injury, describe the treatment received and provide the name and contact details of the healthcare provider. This helps in assessing the severity and validity of the injury.
6. Fill in supervisor and employer information: The first report of injury generally requires the supervisor's contact information and a description of their knowledge about the incident. Additionally, provide your employer's details, including name, address, and contact information.
7. Review and sign the form: After completing all the necessary sections, carefully review the form to ensure accuracy. Once satisfied, sign and date the report, indicating that the information provided is true and correct to the best of your knowledge.

Who needs the first report of injury?

The first report of injury is typically required by employers or organizations to report work-related injuries or accidents. It serves to document the incident and initiate any necessary workers' compensation claims. Additionally, insurance providers and regulatory authorities may also require this report for record-keeping and compliance purposes.

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What is first report of injury?

The first report of injury is a form that must be completed when an employee is injured on the job.

Who is required to file first report of injury?

Employers are required to file the first report of injury when an employee is injured on the job.

How to fill out first report of injury?

The first report of injury can be filled out online or through a paper form provided by the employer.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document the details of the work-related injury for recordkeeping and insurance purposes.

What information must be reported on first report of injury?

The first report of injury must include details such as the date, time, and location of the injury, a description of how it occurred, and the extent of the injury.