Get First Report Of Alleged Occupational Injury Or Illness

Filing the First Report Of Alleged Occupational Injury Or Illness is a crucial step in the workers' compensation process. This guide provides clear and concise instructions on how to fill out this important document online, ensuring that all necessary information is captured accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the employer section. Include the employer's name, address, Federal Employer Identification Number (FEIN), and Standard Industrial Classification (SIC) code. This information is necessary to identify the employer and their business activities.
3. Next, complete the insurance carrier information. Enter the carrier's FEIN, the name of the insurance company, and the relevant policy numbers. Ensure that you also provide the name and contact information for the claim administrator.
4. In the employee section, enter the full name, address, date of birth, and social security number of the injured worker. Indicate their marital status, number of dependents, and provide details about their employment, including their job title and wage.
5. Detail the occurrence of the injury or illness. Enter the date and time of the incident, the location where it occurred, and the specifics of how the injury happened. Include information about any medical treatment received.
6. Provide additional information as required. This includes the injuries sustained, any applicable codes, and whether the employee has been able to return to work since the incident.
7. Finally, review the completed form for accuracy. Once confirmed, you can save changes, download, print, or share the form as needed.

Complete your First Report Of Alleged Occupational Injury Or Illness online today for efficient processing.