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Is injured person earning same wages as before injury If not explain Date of Report Signed by Official Title Tel. No. Form No. 13 WCA 7-89 WHITE LABOR DEPT. Address No. and St. 3. Insured by City and State Zip Code NHADA WCT First Name Middle Initial Last Name S.S. Number 6. THE STATE OF NEW HAMPSHIRE DEPARTMENT OF LABOR Employer s Supplemental Report of Injury This report indicating disability of an employee of four or more days shall be filed as soon as possible after date of knowledge of...
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How to fill out labor form 13 wca
How to fill out labor form 13 wca
01
Read the instructions carefully before filling out the labor form 13 wca.
02
Provide all the necessary personal information such as name, address, and contact details.
03
Specify the type of work for which the form is being filled out.
04
Enter the start and end dates of the employment period.
05
Fill in the details of the wages earned during this period.
06
Provide information regarding any other compensations or benefits received.
07
If applicable, include details of any injuries or illnesses that occurred during the employment period.
08
Attach any relevant supporting documents, such as medical reports or witness statements.
09
Review the completed form for accuracy and completeness.
10
Submit the filled-out labor form 13 wca to the relevant authority.
Who needs labor form 13 wca?
01
Employees who have suffered work-related injuries or illnesses.
02
Employers who are required by law to report such incidents.
03
Insurance companies or healthcare providers who need to process claims.
04
Legal representatives or advocates assisting employees in filing compensation claims.
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What is labor form 13 wca?
Labor form 13 wca is a document used to report work-related injuries and illnesses to the Workers' Compensation Board.
Who is required to file labor form 13 wca?
Employers are required to file labor form 13 wca for any employee who sustains a work-related injury or illness.
How to fill out labor form 13 wca?
To fill out labor form 13 wca, employers must provide details about the employee, the injury or illness, and the circumstances surrounding it.
What is the purpose of labor form 13 wca?
The purpose of labor form 13 wca is to ensure that work-related injuries and illnesses are properly documented and reported for workers' compensation purposes.
What information must be reported on labor form 13 wca?
Information such as the employee's name, date of injury, description of injury, and treatment received must be reported on labor form 13 wca.
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