Get the free First Report of Injury FROI - Employers

KANSAS DEPARTMENT OF LABOR www.dol.ks.gov ACCIDENT REPORT KWC 1101A (Rev. 112) SEE INSTRUCTIONS ON PAGE 2 There is a $250 penalty for repeated failure to file accident reports within 28 days of the

How to fill out first report of injury

How to fill out first report of injury:

1. Collect all relevant information: Gather all necessary details about the injured person, such as their full name, contact information, job title, and the date and time of the injury. Also, note down the location and description of the incident.
2. Report the injury promptly: Ensure that the first report of injury is submitted as soon as possible. Delaying the report may cause complications in processing the claim or accessing necessary benefits.
3. Provide accurate and detailed information: Make sure to include all necessary information regarding the injury, such as the cause, contributing factors, and any witnesses present. Describe the injuries sustained and the medical treatment received.
4. Include employee information: If the injury happened to an employee, provide their employment details, such as their job title, department, supervisor's name, and shift information. This helps in assessing the work environment or identifying any potential safety concerns.
5. Report the injury to the designated authority: Submit the first report of injury to the relevant authority or department responsible for handling such incidents within your organization. This may be the HR department, safety officer, or workers' compensation representative.

Who needs first report of injury:

1. Employers and supervisors: Employers or supervisors need the first report of injury to assess the incident, initiate investigations if required, and determine if any corrective actions or safety measures need to be implemented to prevent similar incidents in the future.
2. Insurance providers: Insurance providers need the first report of injury to process claims for workers' compensation or liability insurance. The report helps them understand the details of the injury and establish the necessary steps, including medical treatment and compensation.
3. Employees: Employees who sustain an injury at the workplace need the first report of injury to initiate a workers' compensation claim or access benefits for medical treatment, lost wages, or rehabilitation services. The report serves as a formal record of the incident and helps protect their rights.

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What is first report of injury?

The first report of injury is a form that details an employee's work-related injury or illness.

Who is required to file first report of injury?

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

How to fill out first report of injury?

The first report of injury should be completed with all relevant details about the injury or illness, including the circumstances surrounding it.

What is the purpose of first report of injury?

The purpose of the first report of injury is to document and report work-related injuries and illnesses for record-keeping and regulatory compliance purposes.

What information must be reported on first report of injury?

The first report of injury must include information such as the date, time, and location of the injury, a description of the injury, and any medical treatment provided.