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DELAWARE INDUSTRIAL ACCIDENT BOARD
PHYSICIANS REPORT OF WORKERS COMPENSATION INJURY
A COPY OF THIS REPORT MUST BE SENT TO THE INJURED WORKER, EMPLOYER AND INSURER
INITIAL REPORT: (PROGRESS REPORT:
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How to fill out report of injury
How to fill out report of injury
01
To fill out a report of injury, follow these steps:
02
Begin by collecting all the necessary information about the injured person, including their name, contact information, and position within the company.
03
Provide a detailed description of the incident that caused the injury, including the date, time, and location.
04
Include any witnesses who can provide additional information about the incident.
05
Describe the extent of the injury and any immediate medical treatment that was provided.
06
Document any equipment or safety measures that may have contributed to the incident.
07
Attach any supporting documentation, such as medical reports or photographs of the scene.
08
Review the report for accuracy and make any necessary edits or additions.
09
Submit the report to the designated person or department responsible for processing injury reports.
10
Keep a copy of the report for your records.
11
Follow up as necessary to ensure the report is being properly processed and any required actions are taken.
Who needs report of injury?
01
A report of injury is typically needed by:
02
- Employees who have been injured while at work
03
- Employers or supervisors who need to document and investigate workplace incidents
04
- Human resources or other relevant departments responsible for tracking and addressing workplace injuries
05
- Insurance companies or legal entities involved in the resolution of workplace injury claims
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What is report of injury?
Report of injury is a form or document that records details of an injury that occurred in the workplace.
Who is required to file report of injury?
Employers are required to file a report of injury when an employee is injured on the job.
How to fill out report of injury?
The report of injury should be filled out with details of the incident, including the date, time, location, description of the injury, and the names of any witnesses.
What is the purpose of report of injury?
The purpose of the report of injury is to document workplace injuries, track trends, and ensure that employees receive proper medical treatment and compensation.
What information must be reported on report of injury?
The report of injury must include details such as the date and time of the injury, the nature of the injury, the name of the injured employee, and any witnesses.
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