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State of New York Workers\' Compensation BoardF5097822First Report of Injury Report Type (MTC) 04Denial This paper contains information that has been provided electronically to the Board. Do not serve

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How to fill out first report of injury

01

Gather all relevant information about the injury, such as the date, time, and location it occurred.

02

Identify the injured person and provide their full name, contact information, and job title.

03

Describe the nature of the injury in detail, including how it happened and any contributing factors.

04

Include witness statements, if available, to support the accuracy of the report.

05

Provide any medical treatment received by the injured person, including hospitalization or visits to a doctor.

06

Fill out any required sections regarding the employer's responsibility, safety protocols, and training provided.

07

Review the report for accuracy and completeness before submitting it to the appropriate department or authority.

Who needs first report of injury?

01

The first report of injury is usually needed by employers, human resources departments, and insurance companies. It helps in documenting workplace injuries, assessing liability and potential legal actions, and handling workers' compensation claims.

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What is first report of injury?

First report of injury is a form that must be completed and submitted to the appropriate state agency whenever an employee is injured on the job.

Who is required to file first report of injury?

Employers are typically required to file the first report of injury on behalf of their employees.

How to fill out first report of injury?

The first report of injury can usually be filled out online or on a paper form provided by the state agency. It typically requires information about the employee, the injury, and the circumstances surrounding the injury.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document workplace injuries, provide information for workers' compensation claims, and identify potential safety hazards in the workplace.

What information must be reported on first report of injury?

Information that must be reported on the first report of injury typically includes the employee's name, contact information, date of injury, description of injury, and any medical treatment provided.

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