Get the free Employee's Statement of Injury or Illness

Get Form

Show details

Employee Statement Date of Incident: ___/___/___ Employee Name: ___ Employee #: ___ Job Title: ___ Campus: ___ Witnesses: ___Please list the details surrounding the event: ___ ___ ___ ___ ___ ___

We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign employees statement of injury

Edit your employees statement of injury form online

Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.

Add your legally-binding signature

Draw or type your signature, upload a signature image, or capture it with your digital camera.

Share your form instantly

Email, fax, or share your employees statement of injury form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit employees statement of injury online

Ease of Setup

pdfFiller User Ratings on G2

Ease of Use

pdfFiller User Ratings on G2

To use the services of a skilled PDF editor, follow these steps:

1

Register the account. Begin by clicking Start Free Trial and create a profile if you are a new user.

2

Simply add a document. Select Add New from your Dashboard and import a file into the system by uploading it from your device or importing it via the cloud, online, or internal mail. Then click Begin editing.

3

Edit employees statement of injury. Rearrange and rotate pages, add and edit text, and use additional tools. To save changes and return to your Dashboard, click Done. The Documents tab allows you to merge, divide, lock, or unlock files.

4

Save your file. Select it from your list of records. Then, move your cursor to the right toolbar and choose one of the exporting options. You can save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud, among other things.

Dealing with documents is always simple with pdfFiller.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.

Learn more about security & compliance

How to fill out employees statement of injury

01

Ensure all necessary information is filled out completely and accurately.

02

Include details about the injury, including the date, time, and location it occurred.

03

Provide a detailed description of how the injury happened.

04

Document any witnesses to the injury.

05

Have the employee sign and date the statement.

Who needs employees statement of injury?

01

Employers who have employees that have experienced work-related injuries.

02

Insurance companies processing workers' compensation claims.

03

Legal representatives handling potential lawsuits related to the injury.

Fill form : Try Risk Free

Rate the form

4.6

Satisfied

29 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

How do I edit employees statement of injury in Chrome?

employees statement of injury can be edited, filled out, and signed with the pdfFiller Google Chrome Extension. You can open the editor right from a Google search page with just one click. Fillable documents can be done on any web-connected device without leaving Chrome.

Can I create an electronic signature for signing my employees statement of injury in Gmail?

Create your eSignature using pdfFiller and then eSign your employees statement of injury immediately from your email with pdfFiller's Gmail add-on. To keep your signatures and signed papers, you must create an account.

How can I edit employees statement of injury on a smartphone?

You can easily do so with pdfFiller's apps for iOS and Android devices, which can be found at the Apple Store and the Google Play Store, respectively. You can use them to fill out PDFs. We have a website where you can get the app, but you can also get it there. When you install the app, log in, and start editing employees statement of injury, you can start right away.

What is employees statement of injury?

Employees statement of injury is a form that employees must fill out to report details of an injury that occurred while on the job.

Who is required to file employees statement of injury?

Employees who have been injured on the job are required to file an employees statement of injury.

How to fill out employees statement of injury?

Employees can fill out the employees statement of injury form by providing details about the injury, how it occurred, and any treatment received.

What is the purpose of employees statement of injury?

The purpose of employees statement of injury is to document the details of an injury that occurred while on the job for insurance and legal purposes.

What information must be reported on employees statement of injury?

Employees must report details such as the date and time of the injury, how it occurred, any witnesses, and any treatment received.

Fill out your employees statement of injury online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now