Get Notice Of Injury Form (c-1) - Risk Management

Filling out the Notice Of Injury Form (C-1) - Risk Management is a critical step for individuals reporting workplace injuries or occupational diseases. This guide provides clear, step-by-step instructions to help users complete the form accurately and effectively in an online format.

Follow the steps to complete the Notice Of Injury Form online.

1. Click the ‘Get Form’ button to access the Notice Of Injury Form (C-1) online and open it in your preferred document editor.
2. Provide the name of the employer in the designated field. Ensure the name is spelled correctly to avoid any discrepancies during processing.
3. Enter the name of the employee who is filing the report. This should match the name on official identification documents.
4. Fill out the employee's Social Security Number. This is necessary for identification and can be kept confidential.
5. Indicate the date of the accident by selecting it from a calendar tool or typing it in the format required.
6. Specify the time of the accident if applicable. Use a 24-hour format to prevent any confusion.
7. Input the telephone number of the employee, making sure to include the area code.
8. Describe the place where the accident occurred, providing as much detail as possible to contextualize the incident.
9. State the nature of the injury or occupational disease. Be clear and concise, detailing the types of injuries sustained or the disease developed.
10. List any body parts that were involved in the injury, if any, ensuring all relevant areas are noted.
11. Give a brief description of the accident or circumstances surrounding the occupational disease. Include dates, if relevant.
12. Provide the names of any witnesses present during the incident. Their accounts may support your claim.
13. Answer whether the employee left work due to the injury or occupational disease, and if first aid was provided.
14. Specify the dates and times when first aid was administered, if applicable.
15. Indicate if the employee has returned to work and by whom they were cleared to do so.
16. Enter the name and address of any treating physician known or applicable.
17. Determine if the accident occurred in the normal course of work and state whether anyone else was involved.
18. Ensure both the supervisor’s signature and the signature of the injured employee are provided along with the respective dates.
19. Review all entered information for accuracy and completeness. Save any changes made to the form.
20. Once satisfied, download, print, or share the completed form as needed, ensuring to retain a copy for personal records.

Complete your Notice Of Injury Form (C-1) online today to ensure your workplace injury is documented and reported accurately.