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FIRST REPORT OF INJURY To report a claim: Call 303.361.4000 or 800.873.7242 Or Fax to 303.361.5000 or 888.329.2251 Or, go to www.pinnacol.com PLEASE PRINT CLEARLYEarly reporting can save you money.

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How to fill out first report of injury

01

Obtain the first report of injury form from your employer or human resources department.

02

Fill out your personal information such as name, address, phone number, and employee ID.

03

Provide details of the injury including date, time, location, and how the injury occurred.

04

Describe the nature of the injury and the body part affected.

05

Include any witnesses to the injury if applicable.

06

Sign and date the form before submitting it to your supervisor or HR department.

Who needs first report of injury?

01

Employees who have suffered a work-related injury or illness that requires medical treatment or time off work.

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What is first report of injury?

The first report of injury is a form that must be completed and filed by an employer when an employee is injured on the job.

Who is required to file first report of injury?

Employers are required to file the first report of injury when an employee is injured on the job.

How to fill out first report of injury?

The first report of injury should be filled out with details about the employee, the nature of 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 and report workplace injuries in order to provide the injured employee with benefits and to prevent future injuries.

What information must be reported on first report of injury?

The first report of injury must include details about the employee, the nature of the injury, and the circumstances surrounding the injury.

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