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TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT EMPLOYERS FIRST REPORT OF WORK INJURY OR ILLNESS JURISDICTION CLAIM # (STATE FILE #)CLAIM TYPE CODE MED ONLY INDEMNITY BECAME LOST TIME BECAME
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How to fill out tennessee first report of

01
Obtain the Tennessee First Report of Injury form from the Tennessee Department of Labor and Workforce Development website or office.
02
Fill out the employee information section, including name, address, Social Security number, and date of birth.
03
Provide details of the injury or illness, including the date, time, and location of the incident.
04
Provide a description of the injury or illness and how it occurred.
05
Include any witnesses to the incident, if applicable.
06
Sign and date the form before submitting it to the appropriate party.

Who needs tennessee first report of?

01
Employers in Tennessee are required to file a First Report of Injury form for any workplace injury or illness that results in lost time or medical treatment.
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Tennessee First Report of is the initial report that businesses must file with the Secretary of State's office.
All businesses that are registered with the state of Tennessee are required to file the First Report.
The First Report can be filled out online through the Secretary of State's website or submitted by mail using the paper form.
The purpose of the First Report is to confirm and update important information about the business with the state.
Information such as the business's name, address, registered agent, and officers/directors must be reported on the First Report.
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