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WORKERS COMPENSATION
FIRST REPORT OF INJURY AND ILLNESS
Answer ALL questions. Sign, and give to your supervisor immediately. Please make and retain a copy for your records.
Section I: EMPLOYEE INFORMATION
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How to fill out first report of injury
How to fill out first report of injury
01
Start by gathering all necessary information about the injured person, such as their full name, contact details, and job title.
02
Document the date and time of the incident, as well as the location where it occurred.
03
Provide a detailed description of the injury, including the body part affected and the nature of the injury (e.g., cut, sprain, etc.).
04
If there were any witnesses to the incident, make sure to collect their names and contact information as well.
05
Include information about any medical treatment received by the injured person, including the name of the treating physician or hospital.
06
Describe any contributing factors or hazards that may have led to the injury, such as faulty equipment or unsafe working conditions.
07
Finally, sign and date the report to certify its accuracy and completeness.
Who needs first report of injury?
01
First report of injury is typically needed by employers, insurance companies, and legal authorities. It helps in documenting and investigating workplace injuries, determining liability, and facilitating workers' compensation claims.
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What is first report of injury?
The first report of injury is a formal documentation submitted to an employer or relevant authority to report an employee's work-related injury or illness.
Who is required to file first report of injury?
Typically, the employer, a supervisor, or the injured employee is required to file the first report of injury.
How to fill out first report of injury?
To fill out the first report of injury, provide detailed information about the injured employee, the nature of the injury, the circumstances surrounding the incident, 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 the incident for record-keeping, facilitate necessary medical treatment, and initiate the workers' compensation claim process.
What information must be reported on first report of injury?
The report should include the employee's details, the date and time of the injury, location, description of the injury, witness information, and any medical treatment provided.
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