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REPORT OF INJURY WORKERS COMPENSATION PROGRAMPHONE: 9288716389 FAX: 9288716083THE NAVAJO NATION P.O. BOX 2489 WINDOW ROCK, AZ 865152489EmployerWorkers Comp Use Only Claim # Date Received1. Name of
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How to fill out report of injury

01
Gather all necessary information about the injury, such as date, time, location, and description of the incident.
02
Identify and document the parties involved in the incident, including any witnesses.
03
Obtain medical records and reports related to the injury, if applicable.
04
Fill out the appropriate sections of the report form, providing accurate and detailed information.
05
Include any supporting documents or evidence, such as photographs or video recordings, if available.
06
Review and double-check the completed report for any errors or missing information.
07
Submit the report to the designated authority or department as per the organization's guidelines.
08
Keep a copy of the report for your records.

Who needs report of injury?

01
Any individual who has suffered a work-related injury
02
Employers or managers responsible for maintaining workplace safety records
03
Insurance companies or legal representatives handling claims related to the injury
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A report of injury is a formal document that details an incident where an individual has sustained an injury, typically in the workplace, and outlines the circumstances surrounding the event.
Typically, employers are required to file a report of injury on behalf of their employees who sustain injuries while performing job-related duties.
To fill out a report of injury, you should include details such as the date and time of the injury, location, a description of the incident, information about the injured person, and any witnesses present.
The purpose of a report of injury is to document the occurrence of an injury for legal, safety, and insurance purposes, ensuring that appropriate actions can be taken following the incident.
Information that must be reported includes the injured person's name, date of injury, nature of the injury, details of the incident, location, and witness information.
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