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COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION AT RICHMOND, OCTOBER 27, 2022PETITION OF4 i\'v× r ^4 1 I.2022 OCT 21 P U: 13 CASE NO. PUR202200124VIRGINIA ELECTRIC AND POWER Company approval
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Gather all necessary information including employer information, employee information, injury details, and medical treatment information.
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Submit the completed form along with any supporting documents to the appropriate contact at the Virginia Workers Compensation Commission.

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Employees who have sustained work-related injuries or illnesses in the state of Virginia.
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Employers who want to report workplace injuries and ensure compliance with workers compensation laws.
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The Virginia Workers' Compensation Commission (workcompvirginiagov) is a state agency that administers the workers' compensation system in Virginia, ensuring that employees who are injured on the job receive necessary benefits and services.
Employers in Virginia who have three or more employees are required to file with the Virginia Workers' Compensation Commission, and they must provide workers' compensation coverage for their employees.
To fill out the necessary forms for the Virginia Workers' Compensation Commission, employers should visit the commission's website to access the relevant forms, provide accurate information about the employee, the nature of the injury, and any medical treatment received.
The primary purpose of the Virginia Workers' Compensation Commission is to oversee the workers' compensation system, ensuring that injured employees receive timely compensation for medical expenses and lost wages, and to adjudicate disputes between employers and employees.
Information reported to the Virginia Workers' Compensation Commission includes the injured employee's details, a description of the injury, the date and location of the incident, medical treatment provided, and any wage loss information.
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