Get State Of New Jersey Employers First Report Of Accidental Injury Or Occupational Illness Form
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How to fill out the State Of New Jersey Employers First Report Of Accidental Injury Or Occupational Illness Form online
Filing the State Of New Jersey Employers First Report Of Accidental Injury Or Occupational Illness Form online is an essential process for employers in the event of workplace injuries or illnesses. This guide provides a clear and supportive approach to completing the form accurately and efficiently.
Follow the steps to fill out the form online effortlessly.
- Click ‘Get Form’ button to access the form and open it for completion.
- In section 1, fill in the carrier name and address, followed by the policy number and effective date. Ensure the expiration date of the policy is also included.
- Enter the date of injury or illness along with the time of day it occurred. Include the OSHA case number if applicable.
- Complete section 3 by providing the firm name, and then fill in the New Jersey registration number or federal employer identification number as required in section 4.
- Fill out the SIC number (section 5) and indicate the number of employees (section 6) at the firm.
- In section 7, provide the mailing address of the employer. Include the business telephone number in section 8, and describe the nature of the business in section 9.
- Enter the employee's full name in section 10 and their social security number in section 11.
- Complete the employee's date of birth (section 12), age (section 13), and sex (section 14), then provide the home address in section 15.
- Indicate the employee's occupation in section 16 and their department where employed in section 17.
- Provide the employee’s home telephone number in section 18 and their wages in section 19, noting whether they are hourly or weekly.
- Specify the number of regular work hours in section 20 and describe where the accident or exposure occurred in section 21.
- Detail what the employee was doing when they were injured in section 22, then describe the object or substance that directly injured them in section 23.
- In section 24, provide information about the nature of the injury or illness and the affected part of the body.
- Answer the questions regarding whether the employee died (section 25), if they were unable to work after the injury (section 26), and if they have returned to work (section 27).
- Finally, fill out the name and address of the treating doctor (sections 28 and 29), and provide information about the hospital if applicable (sections 30 and 31).
- Complete the form by printing or typing your name, title, signature, and the date in the designated areas.
- Once all fields are filled out, ensure all changes are saved. You can download, print, or share the completed form as necessary.
Take action now and fill out your form online to ensure timely reporting.
Workers' compensation laws in New Jersey provide essential protections for employees injured on the job. These laws ensure that workers receive medical benefits, compensation for lost wages, and support for permanent disabilities. The State Of New Jersey Employers First Report Of Accidental Injury Or Occupational Illness Form plays a key role in managing these claims and ensuring compliance with legal requirements. Understanding these laws can help employees navigate their rights and responsibilities effectively.
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