Get Employer's Report Of Work - Related Injury/illness (c2.0) - Pdf

Filing the Employer's Report of Work-Related Injury/Illness (C2.0) is a crucial step for employers in documenting workplace injuries or illnesses. This guide offers clear instructions to help you complete the form accurately and efficiently online.

Follow the steps to effectively complete the form online.

1. Press the ‘Get Form’ button to access and open the Employer's Report of Work-Related Injury/Illness (C2.0) form in your browser.
2. Fill in the top section of the form with the WCB Case Number, Date of Injury/Illness, and Date of this Report, ensuring that all fields are accurate and complete.
3. In Section A, input your employer information: company name, Federal Employer Identification Number (FEIN), mailing address, and contact information. Remember to provide as much detail as possible.
4. Proceed to Section B for insurance details. If you're using an insurance carrier, fill in the Carrier Code Number, name, policy number, and phone number. If self-insured, only enter your Carrier Code Number.
5. Complete Section C with the employee's personal information. Provide their full legal name, date of birth, address, Social Security Number, contact phone number, and gender.
6. In Section D, detail the injury or illness. Include the exact time of the injury, location, and a comprehensive description of how the injury occurred, along with any witnesses present.
7. Fill out Section E by providing details on medical treatment. Include the date of first treatment, name of the treating physician, and any ongoing treatment the employee may be receiving.
8. In Section F, indicate the employee's return to work status. Specify whether they stopped working, the date of return, and if they are working full or limited duty.
9. Complete Section G by recording the employee’s hiring date, job title, and typical work activities. This section may require an attached job description for clarity.
10. In Section H, document the employee's payroll information, including weekly pay and any tips or lodging benefits received.
11. Provide any additional relevant information in Section I and ensure the form is properly signed at the end. If a third party completed it, they should also sign.
12. Once the form is filled out, save your changes. You can then download, print, or share the completed form as needed.

Start completing your Employer's Report of Work-Related Injury/Illness (C2.0) online today to ensure compliance and proper documentation.