Get Employer's Basic Report Of Injury - Pdf

Filling out the Employer's Basic Report of Injury is an important step in managing workplace injuries effectively. This guide will provide you with step-by-step instructions on how to complete the form online, ensuring compliance with necessary reporting requirements.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to access the Employer's Basic Report of Injury form in your preferred online editor.
2. Fill out the employee data section by providing the necessary information such as the employee's social security number, date of injury, full name, address, date of birth, sex, number of dependents, and telephone number.
3. Complete the employer/carrier data section by entering the employer's name, federal ID number, injury location code, mailing location code, and business details.
4. In the injury/medical data section, provide information regarding the last day worked, if the employee died, case number from OSHA/MIOSHA log, and a detailed description of the incident and injury.
5. Finalize the occupation and wage data by filling out the employee’s date hired, total gross weekly wage, occupation specifics, and any relevant details regarding their employment status.
6. Complete the preparer data section, ensuring to include the preparer’s name, signature, telephone number, and date prepared.
7. Review all the entered information for accuracy. Once finalized, save the document, and you may choose to download, print, or share the form as needed.

Start filling out the Employer's Basic Report Of Injury online today to ensure compliance and prompt reporting.