Get Formsworkers' Compensation Divisionnh Department Of Labor

This guide provides a detailed roadmap for filling out the FormsWorkers' Compensation DivisionNH Department of Labor. Utilizing these forms correctly is essential for ensuring that reports of occupational injuries or diseases are handled efficiently and in compliance with state requirements.

Follow the steps to complete the workers' compensation forms online.

1. Click 'Get Form' button to obtain the form and open it for editing.
2. Enter the name of the injured employee. This includes their first name, middle initial, and last name in the respective fields provided.
3. Fill in the date of birth (DOB) and age of the injured employee. This information is critical for verification purposes.
4. Indicate the gender of the injured employee by selecting 'Male' or 'Female' as applicable.
5. Complete the address section, including street number and name, city or town, state, and ZIP code.
6. Provide a contact telephone number for the injured employee. Ensure that it is accurate for easy communication.
7. Detail the occupation of the injured employee at the time of the injury. If the injured was not working in their regular role, include the regular occupation.
8. Record the number of days worked per week, average weekly earnings, and whether the employee was hired in New Hampshire.
9. Document important dates such as when the disability began, the injury date, and the date the supervisor or employer was notified.
10. Provide a detailed description of the incident, including how the accident occurred, what the employee was doing at the time of injury, and parts of the body affected.
11. Indicate whether safeguards were in place during the incident and if equipment contributed to the injury.
12. Complete the sections related to medical treatment received, including the name of the treating physician and any follow-up necessary.
13. If applicable, fill in information about the employee's return to work status, including the date and if they are returning to full or alternative/light duty.
14. After completing all fields, review the information for accuracy. You can save the changes, download, or print the form to share with relevant parties.

Complete the necessary documents online to ensure that your workers' compensation claims are processed smoothly.