Workers Compensation Forms Document For Employers
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FAQ
The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid*.
Return the claim form to your employer in person or by mail. If you mail the claim form, use certified mail ? return receipt requested ? so you have a record of the date it was mailed and the date it was received. If you don't return the completed form to your employer you may risk your right to benefits.
What report is filed? A detailed narrative progress/supplemental report to document any significant change in the worker's medical or disability status.
On the form, you will need to only fill out the ?Employee? section, which asks for basic information: Name, date, and address. Date and location of injury. Brief description of injury. List of injured body parts. Social Security Number.
Workers' Compensation Claim Form (DWC-1) Form DWC-1 is used to file a workers' compensation claim with your employer.
