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WORKERS COMPENSATION FIRST REPORT OF INJURY OR ILLNESS EMPLOYER (NAME & ADDRESS INCL ZIP) CARRIER/ADMINISTRATOR CLAIM NUMBER OSHA LOG NUMBER REPORT PURPOSE CODE JURISDICTION CLAIM NUMBER INSURED REPORT
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ia 1formpdf is a specific form used for reporting purposes.
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ia 1formpdf can be filled out online or manually, following the instructions provided on the form.
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ia 1formpdf requires the reporting of specific financial or personal information.
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