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KANSAS DEPARTMENT OF LABOR www.dol.ks.gov Page 1 of 2 INFORMATION FOR INJURED EMPLOYEES KWC 27 (Rev. 312) * THIS NOTICE APPLIES TO ACCIDENTS ON OR AFTER MAY 15, 2011 * Employers are required to provide

How to fill out information for injured employees

How to Fill out Information for Injured Employees:

1. Begin by collecting the necessary information from the injured employee. This includes their full name, address, phone number, and email address.
2. Next, document the details of the injury incident. Record the date, time, and location of the accident or incident that caused the injury. If there were any witnesses present, gather their contact information as well.
3. Determine the severity of the injury and the type of medical treatment required. This may involve consulting with medical professionals or obtaining medical reports and records.
4. Fill in the employee's job title, department, and supervisor's name. This information is essential for reporting and tracking purposes.
5. Describe the nature of the injury, stating the body part affected and providing a brief description of what happened. It is important to be as specific and detailed as possible.
6. Document all the medical expenses related to the injury. This includes hospital bills, medication costs, physical therapy expenses, and any additional medical treatments required.
7. Be sure to include any supporting documentation, such as incident reports or witness statements, that can provide further context or evidence regarding the injury.
8. Review and verify all the information filled out by the injured employee. Ensure that everything is accurate and complete before submitting the information.

Who Needs Information for Injured Employees:

1. Human Resources Department: They need the information to initiate the company's safety and workers' compensation protocols, assist in filing a claim, and ensure compliance with relevant laws and regulations.
2. Supervisor or Manager: They require the information to understand the circumstances surrounding the injury and implement any necessary corrective actions to prevent similar incidents in the future.
3. Insurance Provider: The insurance provider needs the information to process and evaluate the workers' compensation claim and determine any entitlement to benefits or compensation for the injured employee.
4. Healthcare Providers: Medical professionals involved in the treatment of the injured employee require the information to assess the severity of the injury, provide appropriate medical care, and generate accurate medical records.

Note: Ensure that all sharing of information complies with privacy laws and regulations to protect the confidentiality of the injured employee's personal and medical information.

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What is information for injured employees?

Information for injured employees includes details about a work-related injury or illness suffered by an employee.

Who is required to file information for injured employees?

Employers are required to file information for injured employees.

How to fill out information for injured employees?

Information for injured employees can be filled out by providing the necessary details about the injury or illness on the designated form.

What is the purpose of information for injured employees?

The purpose of information for injured employees is to document and track work-related injuries and illnesses for record-keeping and regulatory compliance purposes.

What information must be reported on information for injured employees?

Information for injured employees must include details such as the date of the incident, the nature of the injury or illness, and the circumstances surrounding the incident.