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EMPLOYERS FIRST REPORT OF INJURY OR ILLNESSForm 122ERevised 2/2019TO BE COMPLETED BY EMPLOYER WITH ORIGINAL SENT TO INSURANCE CARRIER AND COPY SENT TO INJURED WORKERINJURED WORKER INFORMATION: Name:Phone:Address:City:Social

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What is employers first report of?

Employers first report of is the initial report detailing workplace injuries or illnesses that occur within a specified time frame.

Who is required to file employers first report of?

Employers or employers' representatives are required to file the first report of workplace injuries or illnesses.

How to fill out employers first report of?

Employers can fill out the first report of workplace injuries or illnesses by providing details such as the date of the incident, the nature of the injury or illness, and information about the affected employee.

What is the purpose of employers first report of?

The purpose of employers first report of is to document workplace injuries or illnesses, track trends, and ensure appropriate follow-up measures are taken.

What information must be reported on employers first report of?

Employers must report information such as the name of the injured or ill employee, the date and time of the incident, a description of the injury or illness, and any treatment provided.

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