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REPORT OF ONTHEJOB INJURY OR ILLNESS WORKERS COMPENSATION CLAIM FORM Please type or print in ink to complete this form and send electronically to Matt Cunningham at Cunningham Cindy.edu or by campus
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How to fill out workers compensation first report

01
Obtain the necessary forms: Obtain the workers compensation first report form from your employer or insurance company.
02
Gather information: Collect all the necessary information, including the details of the accident or injury, the employee's personal information, and any witnesses.
03
Fill out the form: Start by providing the employee's basic information, such as name, address, and social security number.
04
Provide details of the accident: Describe how the accident or injury occurred, including the date, time, and location.
05
Include medical information: Provide details of any medical treatment received by the employee, including the dates, names of doctors or hospitals, and a description of the treatment.
06
Describe the injury and its impact: Explain the nature of the injury and how it has affected the employee's ability to work.
07
Submit the form: Once the form is completed, submit it to your employer or insurance company as instructed.
08
Follow up: Keep a copy of the form for your records and follow up with your employer or insurance company to ensure it has been received and processed.

Who needs workers compensation first report?

01
Workers compensation first report needs to be filled out by employees who have suffered a work-related injury or illness that requires medical treatment or time off work.
02
Employers and insurance companies also need the workers compensation first report to document and investigate the incident, assess liability, and determine eligibility for workers compensation benefits.
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The workers compensation first report is a form that must be completed by an employer when an employee is injured on the job.
Employers are required to file the workers compensation first report.
The workers compensation first report can be filled out online or by submitting a paper form to the appropriate state agency.
The purpose of the workers compensation first report is to document and report a work-related injury or illness.
The workers compensation first report must include details about the employee, the injury or illness, and the circumstances surrounding the incident.
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