Get Form 5020

Filling out the Form 5020 is an important step for employers to report occupational injuries or illnesses. This guide will provide you with step-by-step instructions to complete the form online, ensuring that you fulfill your reporting obligations clearly and accurately.

Follow the steps to complete the Form 5020 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the firm name in the designated field. Ensure that the name is complete and accurately reflects the company filing the report.
3. Next, input the mailing address, including the number, street, city, and zip code, ensuring all information is current.
4. If the location of the injury or illness differs from the mailing address, provide that information in the appropriate field.
5. Indicate the nature of business by selecting or typing the appropriate description, such as ‘hotel’ or ‘construction’.
6. Select the type of employer from the provided options, indicating whether you are a private entity, state, or county employer.
7. Enter the date of injury or onset of illness in the mm/dd/yy format. Also, input the time when the injury or illness occurred.
8. Proceed to fill out details regarding the employee, such as whether they died, and input their date of death if applicable.
9. Provide the occupation of the employee and add information on their ability to work after the incident, including relevant dates.
10. Fill out the specific injury or illness details, including the part of the body affected and any medical diagnosis available.
11. Include the address and phone number of the physician, if applicable, and indicate whether the employee was hospitalized.
12. Describe the sequence of events leading to the injury or illness in detail in the designated section.
13. Complete any remaining sections, ensuring all necessary information has been provided accurately.
14. Once you have filled out the form, review all entries for accuracy. You can then save your changes, download a copy, print, or share the completed form.

Start completing your Form 5020 online today to ensure compliance with reporting requirements.