Get First Report Of Injury Form For Ri
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How to fill out the First Report Of Injury Form For Ri online
Completing the First Report Of Injury Form is a vital step for employers following a work-related injury. This guide offers comprehensive, step-by-step instructions to ensure that you accurately fill out the form online, promoting a smooth filing process.
Follow the steps to successfully complete the form.
- Click the ‘Get Form’ button to access the First Report Of Injury Form. This will open the document for you to complete the required information.
- Begin by filling in the employer location. Enter the Federal Employer Identification Number (FEIN), employer name, address including city, state, and zip code, as well as the phone number with extension, and the type of business.
- Next, specify if the information about the employer named on the workers' compensation insurance policy is the same as in step 2. If yes, check the 'Same' box and provide the WC policy number. If no, fill out the FEIN, name, address, phone number, and WC policy number for the employer on the insurance policy.
- Fill in the insurance company information by providing the FEIN, name, address, and phone number of the workers' compensation insurance carrier.
- For the claim administrator, enter the required FEIN, name, address, and phone number. If this information is the same as in step 4, check the 'Same' box.
- Complete the employee section with their Social Security Number (SSN), gender, full name as per the social security card, current mailing address, home telephone number, date of birth, occupation, date hired, state of hire, and preferred language.
- In the medical information section, enter the treatment facility's name, address, and phone number where the employee received treatment.
- Provide witness information by listing the name(s) and contact number(s) of individuals who witnessed the injury.
- Detail the injury information: date and time of the injury, time the employee began work, the first full day lost from work, the date returned to work, and the date the employer was notified. If applicable, include the date of death and a description of how the accident occurred.
- Describe the injured body parts and the nature of the injury while indicating where the incident occurred. Check appropriate options regarding previous incidents, if applicable.
- Finally, print the name of the report preparer, the date it was prepared, the phone number, and the name of the employer contact person along with their phone number. If they are the same, check the 'Same' box.
- Review the entire form for accuracy and completeness before saving changes, downloading, printing, or sharing the form as necessary.
Complete the First Report Of Injury Form online to ensure timely compliance with reporting requirements and to facilitate any necessary employee support.
Writing an injury report involves collecting and organizing critical information about the incident. Include the date, time, and precise location, along with a clear description of what happened. Additionally, reference any witnesses and medical evaluations, and follow the guidelines in the First Report Of Injury Form For Ri to ensure your report is comprehensive and compliant.
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