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DWC FORM1 (Employer's First Report of Injury or Illness)The employer is required to file an Employer's First Report of Injury or Illness DWC FORM 1 (Rev. 10/05) with the injured worker's insurance
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How to fill out dwc form -1 rev
01
To fill out the DWC Form -1 Rev, follow these steps:
02
Begin by providing the necessary information about the injured employee, including their name, address, and contact details.
03
Specify the date and time of the injury or illness.
04
Describe the nature of the injury or illness in detail.
05
Indicate the body parts affected by the injury or illness.
06
Include any identifying numbers, such as Social Security number or employee ID.
07
Provide information about the employer, including the company name, address, and contact details.
08
Mention the date and time the employer was notified of the injury or illness.
09
Include details of the medical treatment received by the employee.
10
If the employee lost time from work, indicate the dates of disability and return to work.
11
Sign and date the form to certify its accuracy and completeness.
12
Keep a copy of the completed form for your records.
Who needs dwc form -1 rev?
01
DWC Form -1 Rev is required by employers or their insurance carriers in cases of work-related injuries or illnesses that require medical treatment beyond first aid or result in lost time from work.
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What is dwc form -1 rev?
DWC Form-1 Rev is a form used for reporting workplace injuries and illnesses to the Department of Workers' Compensation.
Who is required to file dwc form -1 rev?
Employers are required to file DWC Form-1 Rev for each workplace injury or illness that occurs to their employees.
How to fill out dwc form -1 rev?
DWC Form-1 Rev can be filled out by providing information about the injured employee, the circumstances of the injury or illness, and any medical treatment received.
What is the purpose of dwc form -1 rev?
The purpose of DWC Form-1 Rev is to report workplace injuries and illnesses in order to track and prevent future incidents.
What information must be reported on dwc form -1 rev?
Information such as the employee's name, date of injury, description of the injury/illness, and details of medical treatment must be reported on DWC Form-1 Rev.
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