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Workers' Compensation. First Report of Injury. You may file your First Report of Injury (Form 101), your Monthly Payment Reports (Form 107) and a Request extension of Time online using the First Report

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How to fill out workers compensation first report

01

Gather all necessary information about the incident, such as date, time, and location.

02

Identify the injured worker's personal details, including name, address, and contact information.

03

Document the nature and description of the injury or illness sustained by the worker.

04

Provide a detailed account of how the injury occurred, including the sequence of events.

05

Include information about any witnesses present at the time of the incident.

06

Complete the employer's portion of the form, including company details and contact information.

07

Ensure all medical treatment details are accurately recorded, such as the healthcare provider's name and address.

08

Submit the completed workers' compensation first report to the appropriate authority within the specified timeframe.

09

Keep a copy of the report for your records and inform the injured worker of their rights and next steps.

Who needs workers compensation first report?

01

Employers are required to file a workers compensation first report for any work-related injury or illness.

02

Employees who sustain a work-related injury or illness that may require medical treatment or time off work should also bring this to their employer's attention.

03

The report is needed to initiate the workers' compensation claim process and ensure the injured worker receives necessary benefits and medical care.

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What is workers compensation first report?

Workers compensation first report is a form that must be completed and submitted by employers to report workplace injuries or illnesses that result in an employee seeking medical treatment or missing work.

Who is required to file workers compensation first report?

Employers are required to file workers compensation first report when an employee sustains a work-related injury or illness.

How to fill out workers compensation first report?

Employers can fill out workers compensation first report by providing detailed information about the injured employee, how the injury occurred, and the medical treatment received.

What is the purpose of workers compensation first report?

The purpose of workers compensation first report is to document and track workplace injuries or illnesses, ensure that employees receive proper medical care, and determine eligibility for workers compensation benefits.

What information must be reported on workers compensation first report?

Information that must be reported on workers compensation first report includes details about the injured employee, the nature of the injury or illness, how it occurred, and the medical treatment received.

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