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MN Department of Labor and Industry Workers Compensation Division PO Box 64221 St. Paul, MN 551640221 (651) 2845032 or 18003425354 Fax: (651) 2845731First Report of Injury See Instructions on Reverse
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To fill out a form related to injury, follow these steps:
02
Start by providing your personal information, such as your full name, address, and contact details.
03
Next, mention the details of the injury, including the date, time, and location of the incident.
04
Describe the nature of the injury and the circumstances surrounding it. Be clear and specific in your description.
05
If there were any witnesses to the incident, provide their names and contact information.
06
Include any medical treatment you received or are currently receiving for the injury.
07
If applicable, mention any insurance information related to the injury.
08
Sign and date the form to acknowledge the accuracy of the information provided.
09
Submit the completed form to the appropriate organization or authority responsible for handling injury claims.

Who needs is related to injury?

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Anyone who has suffered an injury can benefit from filling out a form related to it. This includes:
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- Individuals who have been involved in accidents resulting in personal injuries
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- Employees who have experienced work-related injuries
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- Sports participants who have been injured during a game or training session
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- Anyone else who has suffered an injury and wishes to document it for legal or insurance purposes
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Is related to injury refers to any incident or accident that results in harm or damage to a person's body.
Any person or entity involved in the incident or accident is required to file an is related to injury report.
To fill out an is related to injury report, provide detailed information about the incident, including date, time, location, and nature of the injury.
The purpose of is related to injury reports is to document and investigate incidents that result in injury, to prevent future accidents, and to ensure proper care and compensation for the injured party.
The information that must be reported on an is related to injury report includes the names of individuals involved, the nature and extent of the injuries, any medical treatment provided, and any witnesses to the incident.
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