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State of New York Workers\' Compensation BoardF5098094First Report of Injury Report Type (MTC) Acquired Claim This paper contains information that has been provided electronically to the Board. Do

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How to fill out first report of injury

01

To fill out the first report of injury, follow these steps:

02

Start by providing the necessary information about the injured person, such as their name, address, and contact details.

03

Specify the date and time of the injury.

04

Describe the nature of the injury and how it occurred in detail.

05

Include any witnesses to the incident and their contact information if available.

06

If applicable, provide details about the medical treatment received for the injury.

07

Mention whether the injury resulted in any lost work time and indicate the duration.

08

Add any additional information that may be relevant to the injury report.

09

Sign and date the completed report.

10

Make sure to keep a copy of the report for your records.

Who needs first report of injury?

01

The first report of injury is typically needed by employers, supervisors, and HR departments in workplaces where employees may sustain injuries. It is crucial for documenting and reporting workplace injuries, helping facilitate appropriate measures for worker's compensation claims, insurance purposes, as well as complying with legal requirements.

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What is first report of injury?

The First Report of Injury is a form that must be filled out to report any workplace injuries or illnesses.

Who is required to file first report of injury?

Employers are required to file the First Report of Injury when an employee is injured on the job.

How to fill out first report of injury?

The First Report of Injury can be filled out online or on paper, and it typically requires information such as the employee's name, date of injury, and description of the injury.

What is the purpose of first report of injury?

The purpose of the First Report of Injury is to document workplace injuries and ensure that employees receive proper medical treatment and compensation.

What information must be reported on first report of injury?

Information such as the employee's name, date of injury, description of the injury, and any medical treatment received must be reported on the First Report of Injury.

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