Get the free First Report of Injury Form - DHMH - Maryland.gov - dhmh md
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INSTRUCTIONS COMPLETING EMPLOYEE FIRST REPORT OF INJURY 1. Employee or an individual acting on the employee's behalf completes the Employee First Report of Injury Form. 2. Supervisor or another responsible
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How to fill out first report of injury
How to fill out first report of injury:
01
Gather all necessary information: Begin by collecting all relevant information about the injured person, including their full name, contact information, job title, and department.
02
Document the details of the injury: Describe the incident accurately and thoroughly, including the date, time, and location of the injury. Include specific details such as the cause and nature of the injury, any equipment or machinery involved, and any witnesses present.
03
Provide medical information: Record the injured person's immediate supervisor and whether they received immediate medical attention. Include details about the medical provider, the diagnosis, and any treatment or restrictions given.
04
Include witness statements: If there were any witnesses to the incident, document their statements regarding what they saw or heard. This can provide additional insight and support in case of investigations or claims.
05
Submit the report promptly: It is crucial to submit the first report of injury as soon as possible to the appropriate person or department, such as the human resources department or workers' compensation office. Make sure to follow any specific guidelines or procedures in your organization.
Who needs the first report of injury:
01
The injured person: It is essential for the injured individual to fill out the first report of injury as accurately and thoroughly as possible to ensure their rights are protected and appropriate actions can be taken.
02
Employer or supervisor: The employer or the injured person's immediate supervisor needs the first report of injury to document and understand the incident. This allows them to initiate any necessary investigations, implement safety improvements, and fulfill legal obligations.
03
Human resources department: The HR department plays a critical role in managing workplace injuries by coordinating workers' compensation claims, ensuring compliance with legal requirements, and guiding employees through the process.
04
Workers' compensation insurance provider: The first report of injury is essential for the workers' compensation insurance provider to assess the claim, determine liability, and provide any necessary compensation or benefits to the injured person.
Remember, it is always recommended to consult with your organization's policies and procedures or seek legal advice to ensure that you are filling out the first report of injury accurately and in compliance with any specific requirements.
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What is first report of injury?
First report of injury is a form used to report an employee's work-related injury or illness to the employer's workers' compensation insurance carrier.
Who is required to file first report of injury?
Employers are required to file the first report of injury when an employee is involved in a work-related injury or illness.
How to fill out first report of injury?
The first report of injury form typically requires information such as the employee's name, date of injury, description of injury, and any medical treatment received.
What is the purpose of first report of injury?
The purpose of the first report of injury is to document and report work-related injuries or illnesses in order to initiate the workers' compensation claims process.
What information must be reported on first report of injury?
The first report of injury generally requires information about the employee, the injury or illness, and any medical treatment received.
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