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Workers Compensation First Report of Incident Complete this form with your supervisor and send via email to the Office of Risk Management (riskmanagement@marquette.edu) or drop off to, Alexa GianosSteinberg,
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How to fill out workers compensation first report

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How to fill out workers compensation first report

01
Step 1: Obtain the necessary forms. You can usually find the workers compensation first report form on your state's workers compensation board or insurance company website.
02
Step 2: Gather all relevant information. This includes the injured employee's personal details, date and time of the accident, location of the accident, description of the injury, and any witnesses present.
03
Step 3: Fill out the employer section. Provide your company's name, address, contact information, and workers compensation insurance policy details.
04
Step 4: Complete the employee section. Enter the injured employee's name, contact information, job title, and employment details.
05
Step 5: Provide details about the accident. Describe how the injury occurred, the specific body parts affected, and any contributing factors.
06
Step 6: Include any medical treatment received. Note the healthcare provider's details, diagnosis, treatment provided, and any restrictions on the employee's work activities.
07
Step 7: Submit the report. Once the form is filled out accurately, sign and date it, and submit it as required by your state's workers compensation regulations.

Who needs workers compensation first report?

01
Employers who have employees covered by workers compensation insurance need to fill out the workers compensation first report.
02
Injured employees or their representatives may also need to provide this report to initiate the workers compensation claims process.
03
Insurance companies and workers compensation boards use this report to assess the validity of a claim and determine appropriate compensation.
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Workers compensation first report is the initial report filed by an employer when an employee is injured on the job.
Employers are required to file the workers compensation first report when an employee is injured on the job.
Employers must include details of the injury, the date and time it occurred, and any witness statements when filling out the workers compensation first report.
The purpose of the workers compensation first report is to document and report workplace injuries in order to provide benefits to injured employees.
Information such as the employee's name, date of injury, time of injury, location of injury, and details of how the injury occurred must be reported on the workers compensation first report.
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