Get the free First Report of Injury

This form is used to report an employee\'s work-related injury or illness, including detailed information such as the employee\'s personal details, incident description, and supervisor\'s information. It instructs on the process for filing the report and necessary steps involving workers\' compensation benefits.

How to fill out first report of injury

How to fill out first report of injury

1. Start by gathering information: Collect details about the injured person, including their name, address, and job title.
2. Include the date and time of the incident: Record when the injury occurred.
3. Describe the location of the incident: Specify where the injury took place, such as the workplace or job site.
4. Provide a detailed description of the injury: Explain what happened and how the injury occurred.
5. List any witnesses: Include names and contact information of individuals who saw the incident.
6. Complete the employer's section: Fill out employer information, including the company name and address.
7. Sign and date the report: The employee and the employer or supervisor should sign the report to confirm accuracy.
8. Submit the report: Send the completed report to the appropriate insurance company or state office as required.

Who needs first report of injury?

1. Employees who experience a workplace injury.
2. Employers or supervisors responsible for incident reporting.
3. Insurance companies that need documentation for claims.
4. Health and safety officials who monitor workplace injuries.

For pdfFiller’s FAQs

How do I modify my first report of injury in Gmail?

You may use pdfFiller's Gmail add-on to change, fill out, and eSign your first report of injury as well as other documents directly in your inbox by using the pdfFiller add-on for Gmail. pdfFiller for Gmail may be found on the Google Workspace Marketplace. Use the time you would have spent dealing with your papers and eSignatures for more vital tasks instead.

How can I modify first report of injury without leaving Google Drive?

By integrating pdfFiller with Google Docs, you can streamline your document workflows and produce fillable forms that can be stored directly in Google Drive. Using the connection, you will be able to create, change, and eSign documents, including first report of injury, all without having to leave Google Drive. Add pdfFiller's features to Google Drive and you'll be able to handle your documents more effectively from any device with an internet connection.

How do I edit first report of injury straight from my smartphone?

The easiest way to edit documents on a mobile device is using pdfFiller’s mobile-native apps for iOS and Android. You can download those from the Apple Store and Google Play, respectively. You can learn more about the apps here. Install and log in to the application to start editing first report of injury.

What is first report of injury?

The first report of injury is a formal document that an employer or employee completes to notify the relevant authorities or workers' compensation board about a work-related injury.

Who is required to file first report of injury?

Typically, the employer is required to file the first report of injury, but employees can also be involved in reporting if they are the ones filing for workers' compensation benefits.

How to fill out first report of injury?

To fill out the first report of injury, one should provide detailed information about the incident, including the date and time of the injury, a description of how it occurred, the nature of the injury, and any medical treatment received.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document the incident and initiate the claims process for workers' compensation, ensuring that the injured employee receives appropriate medical care and benefits.

What information must be reported on first report of injury?

Information that must be reported includes the employee's name and contact information, the employer's name and contact details, details about the injury (type, location, cause), and any witnesses to the incident.