Get Accident Report State Of Tennessee Division Of Claims Administration Form
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How to fill out the Accident Report State Of Tennessee Division Of Claims Administration Form online
Filing an accident report is an important step for state employees seeking workers' compensation. This guide provides clear and detailed instructions on how to accurately fill out the Accident Report Form online, ensuring you provide all necessary information for a successful claim.
Follow the steps to fill out the Accident Report Form accurately and effectively.
- Click ‘Get Form’ button to obtain the form and open it for editing.
- Begin by entering your personal details in the designated fields, including your full name and birthdate, ensuring accurate entries.
- Provide your home address, including city, state, and zip code. It's important to include your home phone number as well.
- Fill in your supervisor's name along with your job title and the corresponding state agency.
- Indicate the date you were employed by the state and describe the exact location of the project where the injury occurred.
- Answer whether your duties require you to be at the location where the injury happened.
- State whether you left work on the day of the injury and, if not, indicate when your incapacity began.
- Enter the date of the accident and follow with a detailed description of the injury, including the machine, tool, or appliance involved.
- Describe the nature of the injury and identify what part of your body was impacted.
- Provide the probable length of disability and mention if any time was lost from work due to the injury.
- Fill in your physician’s name and contact information, stating when the first visit occurred.
- Indicate who authorized the visit to the physician and whether hospitalization was required.
- The supervisor must then complete their section by stating the employee's position at the time of the injury and whether it was caused by misconduct, self-inflicted injury, intoxication, safety negligence, or a legal duty failure.
- Provide the date and time the first notice of injury was given to the employer, including who was informed.
- Complete the salary details, confirm whether the employee will be on unpaid leave during disability, and summarize their knowledge of the incident.
- Ensure all statements are signed and dated by both the claimant and the supervisor before submission.
Complete the Accident Report Form online to ensure your compensation claim is processed smoothly.
In Tennessee, it is necessary to file an accident report for any crash that results in injury, death, or property damage exceeding $1,500. This report helps establish the details of the incident and is crucial for any insurance claims. To ensure compliance with state law, you can use the Accident Report State Of Tennessee Division Of Claims Administration Form. This form streamlines the process and makes it easier for you to submit your report.
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