Get E3301

Filling out the E3301 form is an essential step in filing a workers’ compensation claim. This guide will provide you with clear instructions to help you navigate the online completion of the form effectively.

Follow the steps to fill out the E3301 online seamlessly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with completing the 'Employee' section, entering your name, today’s date, home address, and zip code.
3. Provide the city and state where you reside.
4. Input the date and time of the injury, noting whether it occurred in the morning or afternoon.
5. Describe the location where the injury occurred, including address details.
6. Clearly outline the nature of your injury and specify the part of the body affected.
7. Enter your Social Security Number for identification.
8. Finally, sign the form to confirm the information provided is accurate.
9. Submit the completed form to your employer and keep a copy marked as ‘Employee’s Temporary Receipt’ until you receive the dated copy from them.
10. Upon receiving the dated copy from your employer, ensure they also send one copy to the claims administrator.
11. After completing the above steps, you may save changes, download, print, or share the form as needed.

Complete your E3301 form online now to ensure timely processing of your workers' compensation claim.