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WORKERS COMPENSATION FIRST REPORT OF INJURY OR ILLNESS EMPLOYER (NAME & ADDRESS INCL ZIP)CARRIER/ADMINISTRATOR CLAIM NUMBER OSHA LOG UNDERREPORT PURPOSE CODEJURISDICTIONJURISDICTION CLAIM NUMBERINSURED

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What is agent name amp code?

Agent name amp code refers to the unique identifier assigned to the agent representing a particular entity.

Who is required to file agent name amp code?

Any entity that has an agent representing them is required to file agent name amp code.

How to fill out agent name amp code?

To fill out agent name amp code, the entity must provide the necessary information about the agent representing them.

What is the purpose of agent name amp code?

The purpose of agent name amp code is to accurately identify the agent representing an entity.

What information must be reported on agent name amp code?

The information reported on agent name amp code must include the name and contact information of the agent.

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