Get Workers Compensation - First Report Of Injury Or Illness Carrier/claims ... - State Sc

Filling out the Workers Compensation - First Report Of Injury Or Illness form is crucial for documenting workplace injuries and illnesses. This guide provides a clear, step-by-step approach to complete the form accurately, ensuring that all necessary details are captured.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to receive the form and open it for editing.
2. Enter the employer's name and address, including the ZIP code, at the top of the form. If the employer has multiple locations, indicate the specific location where the incident occurred.
3. Fill in the carrier or claims administrator details, including their name, address, and phone number. Make sure to include the applicable claim number and policy information.
4. In the employee section, provide the full name, birth date, social security number (without dashes), and hire date of the affected person. Include their address, employment status, occupation, and phone number as well.
5. Detail the occurrence and treatment information by entering the time the employee began work, date and time of the injury or illness, and the last work date. Specify any medical treatment received and name the physician or healthcare provider.
6. Indicate the part of the body affected by the injury/illness and describe the sequence of events that led to the incident. Include specifics about the equipment, materials, or chemicals the employee was using.
7. Confirm whether proper safety equipment was provided and used. Document any witnesses to the incident and fill in the date the administrator was notified, along with the preparer's name, title, and contact number.
8. Review all completed sections to ensure accuracy. Once the form is complete, you can save changes, download it, print it, or share it as needed.

Complete your forms online to ensure a smooth filing process.