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Get Form 19 Fillable
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How to fill out the Form 19 Fillable online
This guide provides clear instructions on how to complete the Form 19 Fillable online. It is designed to assist users of all experience levels in accurately filling out the necessary fields for reporting an employee's injury or occupational disease.
Follow the steps to complete the Form 19 Fillable
- Click the ‘Get Form’ button to access the Form 19 Fillable. This will allow you to open and begin editing the document.
- Enter the IC File Number provided in your correspondence. This unique identifier is crucial for referencing future communications regarding the injury.
- Fill in the Employer Code and other employer-related details, such as the employer's name, address, and FEIN. This information is essential for identifying the organization responsible for the report.
- Input the Employee's Name and Social Security Number. Be careful to ensure accuracy as this information directly pertains to the person injured.
- Indicate the nature of the employer’s business and the location where the injury occurred, including county and department. Include the exact date and time of the injury.
- Complete the sections detailing the injured person's occupation, wages, and employment duration. This includes current wages, hours worked, and the overall weekly earnings.
- In the section describing the nature of the injury, provide a detailed account of how the injury occurred. This is crucial for proper documentation.
- If applicable, specify any assistance the injured employee received, including medical treatment details and any relevant dates.
- Check all fields for completeness and accuracy. It is important that every question is answered to comply with legal requirements.
- Once you have filled in all required sections, save any changes made. You can then download, print, or share the completed Form 19 as needed.
Complete and submit the Form 19 Fillable online to ensure your report is properly filed.
Yes, you can submit Form 19 offline by downloading and printing the form, then filling it out by hand. After completing the form, take it to the relevant office along with the required documents. Although online submission is convenient, using a Form 19 Fillable for offline applications can help ensure your form is completed accurately.
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