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WORKERS COMPENSATION FIRST REPORT OF INJURY OR ILLNESS Employer (Name & Address incl. zip)Carrier/Administrator Claim Number JurisdictionGeneralEmployers Location Address (if different)Carrier/Claims
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Gather all necessary information such as employee details, nature of injury, date and time of injury, location of injury, witness statements, etc.
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Complete the first report of injury form accurately and thoroughly.
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Submit the completed form to the appropriate authority within the specified time frame.

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Employers are required to fill out the first report of injury form for any work-related injuries or illnesses that occur to their employees.
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The first report of a workers' compensation claim is the initial report filed with the employer's insurance company to notify them of an employee's work-related injury.
Employers are required to file the first report of a workers' compensation claim when an employee is injured on the job.
The first report of a workers' compensation claim typically includes details about the employee, the injury, and the circumstances surrounding the incident.
The purpose of the first report of a workers' compensation claim is to initiate the claims process and provide the insurance company with necessary information to evaluate and process the claim.
Information that must be reported on the first report of a workers' compensation claim includes the employee's name, date of injury, description of the injury, and details of how the injury occurred.
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