Get the free First Report of Injury - Assigned Risk Plan

First Report of Injury MN Department of Labor and Industry Workers Compensation Division PO Box 64221 St. Paul, MN 551640221 (651) 2845032 or 18003425354 Fax: (651) 2845731 1. EMPLOYEE SOCIAL SECURITY

How to fill out first report of injury

How to fill out first report of injury

1. Gather all necessary information such as the employee's personal details, date and time of injury, location of injury, and a detailed description of how the injury occurred.
2. Ensure that the first report of injury form is readily available. This may be obtained from the employer or the human resources department.
3. Start by filling out the employee information section, including the name, address, contact details, and job title of the injured employee.
4. Provide a clear and concise description of the injury, specifying the body part affected and the severity of the injury.
5. Include any contributing factors that may have led to the injury such as unsafe work conditions or equipment malfunction.
6. If there were any witnesses to the incident, record their names and contact information.
7. Attach any relevant documentation such as medical reports, photographs, or witness statements.
8. Review the completed form for accuracy and completeness before submitting it to the appropriate personnel or department.
9. Retain a copy of the first report of injury for record-keeping purposes.

Who needs first report of injury?

1. Employees who have sustained a work-related injury or illness need to fill out the first report of injury.
2. Employers need the first report of injury to comply with legal requirements, initiate appropriate workers' compensation processes, and ensure the injured employee receives necessary medical care and benefits.
3. Human resources departments, safety officers, and other relevant personnel also require the first report of injury for record-keeping, analysis of workplace incidents, and implementation of safety improvements.

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What is first report of injury?

First report of injury is a form that employers are required to fill out and submit to the appropriate state agency 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?

Employers can fill out the first report of injury form with all the necessary information about the employee, the injury, 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 workplace injuries, track trends, and ensure that employees receive appropriate benefits and medical treatment.

What information must be reported on first report of injury?

Information that must be reported on the first report of injury includes the employee's name, date of injury, description of the injury, and details about the incident.