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Get Minnesota Department Of Labor And Industry First Report Of Injury

Minnesota Department of Labor and Industry Workers Compensation Division PO Box 64221 St. Paul, MN 55164-0221 (651) 284-5030 First Report of Injury See Instructions on Reverse Side PRINT IN INK or.

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Form: First Report of Injury - Minnesota...
Items 46 - 54 — MN Department of Labor and Industry. Workers' Compensation Division...
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Call the nearest OSHA office. Call the OSHA 24-hour hotline at 1-800-321-6742 (OSHA).

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*.

The employer is required to file an Employer's First Report of Injury or Illness [DWC FORM-001 Rev. 10/05] with the injured worker's insurance carrier, and the injured claimant or the claimant's representative within 8 days after the employee's absence from work or receipt of notice of occupational disease.

Report the Injury If you are injured at work, you should immediately (or as soon thereafter as possible) report your injury to your employer or immediate supervisor. Your employer is required to fill out a form, sometimes called a "First Report of Injury," for every injury which occurs in the workplace.

A. Report the injury to your employer by telling your supervisor right away. If your injury or illness developed over time, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps prevent problems and delays in receiving benefits, including medical care you may need.

1). Within eight hours of the occurrence, the employer must also call the Minnesota Occupational Safety and Health Administration (MnOSHA) at (651) 284-5050 or (877) 470-6742. All other work-related injuries or illnesses must be reported within 10 days of the employer's first knowledge of its occurrence (Minn. Stat.

Supervisor Responsibilities When an injury does occur, supervisors are expected to directly respond and assist the injured employee in receiving the appropriate medical treatment. A supervisor, should never be in a situation where one of their employees is injured and they don't know about it.

Within 14 days – If you tell your employer within 14 days after your injury, your notice is on time. The employer cannot deny your workers' compensation claim because you gave late notice of the injury.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232