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REPORT OF INJURY / COMPLAINT OF INJURY State Form 47400 (1295) INDIANA PROFESSIONAL LICENSING AGENCY 302 WEST WASHINGTON STREET, ROOM E034 INDIANAPOLIS, IN 462042700 (317) 2322980 IC 16147 SEC. 18
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How to fill out 47400pdf report of injury

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Start by opening the 47400pdf report of injury form on your computer.
02
Fill out the personal information section with your name, address, and contact details.
03
Provide the date and time of the injury in the corresponding field.
04
Describe the circumstances of the injury in detail, including any witnesses or contributing factors.
05
Indicate the severity of the injury and any medical treatment received.
06
If applicable, mention any previous injuries or medical conditions that may be relevant.
07
Sign and date the form to certify its accuracy.
08
Optional: Attach any supporting documentation, such as medical records or witness statements.
09
Review the completed form to ensure all information is accurate and complete.
10
Save the filled-out form and make copies for your records, as well as any relevant parties.

Who needs 47400pdf report of injury?

01
Employees who have experienced a work-related injury or illness need to fill out the 47400pdf report of injury.
02
Employers or supervisors may also need to complete this form if they are aware of an employee's injury or are responsible for reporting it.
03
Insurance companies, medical professionals, and legal authorities may require the 47400pdf report of injury for claim processing, treatment purposes, or legal proceedings.
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The 47400pdf report of injury is a form used to report work-related injuries and illnesses.
Employers are required to file the 47400pdf report of injury for any work-related injury or illness that occurs.
To fill out the 47400pdf report of injury, you need to provide details about the injured employee, the injury or illness, and the circumstances surrounding the incident.
The purpose of the 47400pdf report of injury is to document and track work-related injuries and illnesses for safety and health recordkeeping purposes.
The 47400pdf report of injury must include information such as the employee's name, date of injury, description of the injury, and any medical treatment received.
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