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Workers Compensation Unit One Ashburn Place, 3rd Floor Boston, MA 02108NOTICE OF INJURY/ILLNESS REPORT This form is intended for internal use for all Human Resources Division/Workers Compensation
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How to fill out notice of injury report

01
To fill out a notice of injury report, follow these steps:
02
Start by providing your personal information such as name, address, and contact details.
03
Provide the date and time of the incident or injury.
04
Describe the details of the incident or injury, including the location and any contributing factors.
05
Include information about any witnesses to the incident.
06
Mention the names and contact details of any individuals involved in the incident.
07
Include a description of the injuries sustained and any medical treatment received.
08
Sign and date the form to indicate your understanding and agreement with the provided information.
09
Keep a copy of the completed notice of injury report for your records.
10
Note: It is recommended to consult with legal or medical professionals for specific guidance related to your situation.

Who needs notice of injury report?

01
Notice of injury report is typically needed in situations where an individual has suffered an injury or incident that may have legal or insurance implications.
02
The following parties may require a notice of injury report:
03
- Employees who experience work-related injuries or accidents
04
- Individuals involved in car accidents
05
- Participants in sports or recreational activities where injuries occur
06
- Victims of personal injuries caused by someone else's negligence
07
This report helps document the incident or injury, providing a record that may be useful for insurance claims, legal proceedings, or future reference.
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Notice of injury report is a document that employees use to report any work-related injuries or illnesses to their employer.
All employees who suffer a work-related injury or illness are required to file a notice of injury report with their employer.
Employees can fill out the notice of injury report by providing details about the injury or illness, including the date, time, and location of the incident.
The purpose of notice of injury report is to document and track work-related injuries and illnesses in order to ensure proper treatment and workers' compensation.
Information that must be reported on notice of injury report includes the employee's name, contact information, date of birth, job title, a description of the injury or illness, and any medical treatment received.
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