Get Libc 344 Rev 1 02
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How to fill out the Libc 344 Rev 1 02 online
Filling out the Libc 344 Rev 1 02 form is an essential step in reporting occupational injuries or diseases. This guide will provide you with detailed instructions to complete the form accurately and efficiently, helping ensure the necessary information is submitted correctly.
Follow the steps to complete the Libc 344 Rev 1 02 form online.
- Press the ‘Get Form’ button to access the document and open it in your editing tool.
- Begin by entering the employee’s address and phone number at the top of the form. Ensure that this is the home information, not work-related details.
- For the dates, input all dates in the format MMDDCCYY, such as 01012002 for January 1, 2002.
- Input phone numbers including the area code, for example, 4126241198.
- Record the time in HHMM format and check the appropriate AM or PM box. Avoid using military time.
- If the employee has not lost time from work, enter the injury date as the date returned to work.
- Fill in the contact name and number as the designated Workers’ Compensation administrator from the appropriate department.
- In the Type of Injury or Illness section, briefly describe the injury, such as 'fracture' or 'sprain.'
- Specify the affected parts of the body, like 'left wrist' or 'lower back.'
- Indicate the cause of the injury succinctly, for example, 'fell from ladder' or 'cut from broken glass.'
- Provide a brief narrative regarding any equipment used and how the injury or illness happened.
- Check any applicable boxes under Initial Treatment.
- If medical treatment was given before submitting the form, include the physician or health care provider's information.
- Enter the policy number and policy period as this is required for Risk Management use.
- If applicable, provide the witness's name and phone number.
- Complete the Person Completing This Form section, ensuring the supervisor signs and dates the form.
- Submit the completed form immediately to the Risk Management Office via fax at 610-758-5855, and send the signed original through campus mail.
Complete your Libc 344 Rev 1 02 form online today to ensure timely reporting.
To file a workers' comp claim in Pennsylvania, start by reporting your injury to your supervisor and completing the Libc 344 Rev 1 02 form. Submit this form to your employer, who will then send it to their insurance carrier. It is crucial to follow up and ensure that your claim is being processed. Utilizing platforms like US Legal Forms can provide you with the necessary documents and guidance to enhance your filing experience.
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