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WEST MICHIGAN PLUMBERS, FITTERS AND SERVICE TRADES LOCAL UNION NO. 174 HEALTH & BENEFIT FUND 6525 Centurion Drive Lansing, MI 48917 Toll Free: 8554075862 LOSS OF TIME FORM (Note: Participant must

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How to fill out 1174 loss of time

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Open the form 1174 loss of time

02

Start by filling out your personal information such as name, address, and contact details

03

Read the instructions carefully to understand the purpose of the form

04

Provide detailed information about the incident that led to the loss of time

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Include any supporting documents or evidence that may be required

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Fill out the date, time, and duration of the loss of time

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List any witnesses or individuals who can verify your claim

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09

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Who needs 1174 loss of time?

01

Employees who have experienced a loss of time due to an incident or injury

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Individuals who need to report and document their absence from work or other activities

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People who require compensation or reimbursement for the time lost

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Anyone who wants to officially record and validate their claim of time lost

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What is 1174 loss of time?

1174 loss of time refers to documenting the time lost due to an accident or injury while on duty.

Who is required to file 1174 loss of time?

Employees who have experienced an accident or injury while on duty are required to file 1174 loss of time.

How to fill out 1174 loss of time?

To fill out 1174 loss of time, employees need to provide details of the accident or injury, the time lost, and any relevant medical documentation.

What is the purpose of 1174 loss of time?

The purpose of 1174 loss of time is to track and document the time lost by employees due to accidents or injuries while on duty.

What information must be reported on 1174 loss of time?

Information such as the date and time of the accident, details of the injury, time lost, and any medical documentation must be reported on 1174 loss of time.

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