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EMPLOYERS REPORT OF INDUSTRIAL INJURY TO BE FILLED OUT BY EMPLOYERSubmit Report to:BERKLEY RISK ADMINISTRATORS COMPANY, LLC PO BOX 59143 MINNEAPOLIS, MN 554590143Complete and return this report to

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How to fill out first report of injury

01

Gather all necessary information such as employee details, date and time of injury, location of injury, description of injury, and names of any witnesses.

02

Fill out the required forms provided by your employer or insurance company, making sure to include all relevant details.

03

Submit the completed report to the appropriate person or department within the specified timeframe.

04

Keep a copy of the report for your records.

Who needs first report of injury?

01

First report of injury is needed by employers to document workplace injuries and ensure that employees receive proper compensation and medical treatment.

02

Insurance companies also require a first report of injury to process claims and determine liability.

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What is first report of injury?

The first report of injury is a document that formally records the details of an injury sustained by an employee while performing work-related duties.

Who is required to file first report of injury?

Typically, the employer or the supervisor is required to file the first report of injury.

How to fill out first report of injury?

To fill out the first report of injury, include essential details such as the employee's personal information, a description of the injury, the circumstances surrounding the incident, and any medical treatment provided.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document the occurrence of a workplace injury for legal, insurance, and workplace safety purposes.

What information must be reported on first report of injury?

Information that must be reported includes the employee's name, job title, date of injury, time of injury, location, nature of the injury, and any witnesses.

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