Get Report Of Injury - Firstcomp

This guide offers a clear and supportive approach to completing the REPORT OF INJURY - FirstComp form online. Ensuring that you fill out this form accurately can help facilitate the workers' compensation process effectively.

Follow the steps to successfully complete the REPORT OF INJURY - FirstComp form.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing the employer's name, full address including ZIP code, and any relevant identifiers such as the employer’s FEIN. Make sure to verify that all information is accurate.
3. Enter the employee's information, including their full name (last, first, middle), date of birth, address, and contact number. Ensure that the Social Security number is correctly recorded.
4. Document the injury details by including the date and time of occurrence, the type of injury or illness, and whether the event occurred on the employer’s premises.
5. Provide specific details about the injury incident, including a description of how the injury occurred, any equipment or materials involved, and statements about whether safety equipment was provided and used.
6. In the treatment section, indicate the health care provider's information and the initial treatment received. Use the codes provided for the extent of medical treatment.
7. Complete any additional information required such as the date returned to work, last work date, and any witness details.
8. Review all the entered information for accuracy. Once confirmed, you can save changes, download, print, or share the completed form.

Complete your REPORT OF INJURY - FirstComp form online today to ensure accurate and timely processing.