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Employees First Report of Injury or Illness Workers Compensation 1. Name (Last, First, Middle Initial)2. Sex Female Male15. Date of Injury (MAY) :AIS DID Number3. Social Security Number17. Date Lost
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How to fill out date of injury m-d-y
How to fill out date of injury m-d-y
01
To fill out the date of injury m-d-y, follow these steps:
02
Locate the field on the form or document where the date of injury is required.
03
Start by typing the month in two-digit format. For example, if the injury occurred in January, enter '01'.
04
Next, type the day in two-digit format. For example, if the injury occurred on the 15th, enter '15'.
05
Finally, type the year in four-digit format. For example, if the injury occurred in 2021, enter '2021'.
06
Once you have entered all three components (month, day, and year), separate them using hyphens. For example, if the injury occurred on January 15, 2021, the complete date would be '01-15-2021'.
07
Double-check the entered date to ensure accuracy and completeness.
08
Submit the form or document with the correctly filled out date of injury m-d-y.
Who needs date of injury m-d-y?
01
The date of injury m-d-y is typically required by various parties involved in legal or insurance processes, including:
02
- Insurance companies: When processing a claim related to the injury.
03
- Attorneys: When filing a lawsuit or handling a case involving the injury.
04
- Government agencies: When documenting and investigating workplace or personal injuries.
05
- Healthcare providers: When maintaining medical records or assessing the timeline of treatment.
06
- Employers: When reporting workplace injuries or accidents to the appropriate authorities.
07
- Individuals: When providing accurate information about the date of their injury for any legal or personal purposes.
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