Loading
Get Dwc Form-001 (employer's First Report Of Injury Or Illness) The ...
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the DWC FORM-001 (Employer's First Report Of Injury Or Illness) online
Filling out the DWC FORM-001 is a crucial step in reporting an injury or illness that affects an employee. Prompt submission ensures compliance with legal requirements and supports the injured party in securing their claims.
Follow the steps to effectively complete the DWC FORM-001.
- Click ‘Get Form’ button to access the DWC FORM-001 and open it in the document editor.
- Fill in the employee's name (last name, first name, middle initial) accurately in the designated field.
- Enter the employee’s social security number in the appropriate section to ensure their identity is clearly established.
- Provide a contact phone number where the employee can be reached, even if there is no home phone.
- Input the employee's date of birth using the month, day, year format (m-d-y).
- Record the date of injury using the same date format and specify the time of the injury.
- Detail the nature of the injury or illness in the appropriate field, describing the exact circumstances of the incident.
- Identify the specific part of the body injured or exposed, listing each affected area if there is more than one.
- Describe how and why the injury occurred by providing a detailed account of the events leading up to the incident.
- Complete all remaining sections of the form including the employer's identification details and submit the report to the workers' compensation insurance carrier and the injured employee.
Ensure timely completion and submission of the DWC FORM-001 online to facilitate the claims process.
Related links form
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*.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.