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CLEMSON UNIVERSITY WORKERS COMPENSATION REPORT OF INJURY EMPLOYEE NAME: ___ DEPT NUMBER: ___ HOME ADDRESS: ___ DATE OF ACCIDENT: ___ TIME OF ACCIDENT: ___ a.m. ___p.m. DATE SUPERVISOR NOTIFIED OF
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How to fill out workers compensation-first report of

01
Gather all relevant information related to the injury, including the date, time, and location of the incident.
02
Fill out the employee information section with details such as name, address, job title, and contact information.
03
Describe the circumstances of the injury in the incident report section, including how it occurred and any witnesses present.
04
Include information about any medical treatment received or scheduled for the injury.
05
Complete the employer section with details about the company and supervisor information.
06
Review the form for accuracy and completeness before submitting it to the appropriate parties.

Who needs workers compensation-first report of?

01
Employers are required to fill out and submit the workers compensation-first report of in the event of an employee injury on the job.
02
Insurance companies and legal representatives may also need access to this report for processing claims and legal purposes.
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Workers' compensation-first report of is a form that must be completed by an employer when an employee is injured or becomes ill on the job.
Employers are required to file the workers' compensation-first report of when an employee is injured or becomes ill on the job.
The form should be filled out with details of the employee's injury or illness, as well as any relevant information about the circumstances surrounding the incident.
The purpose of the workers' compensation-first report of is to document and report any injuries or illnesses that occur in the workplace, so that the employee can receive appropriate medical treatment and compensation.
The form typically requires information such as the employee's name, date and time of injury, location of injury, details of the injury or illness, and any witnesses to the incident.
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