Get First Report Of Injury Or - Kentucky Retail Federation - Self Insurers ... - Krfsif

Filing a First Report of Injury or Illness is essential for documenting workplace incidents efficiently. This guide provides clear, step-by-step instructions to help users accurately complete the form online, ensuring compliance with necessary requirements.

Follow the steps to fill out the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the document and open it in your preferred PDF viewer.
2. Begin by entering the employer's name and address, including the zip code. Ensure accuracy as this information is vital for identification purposes.
3. Fill in the carrier or administrator claim number along with the jurisdiction, noting this information can expedite processing.
4. If the employer’s location differs from their main address, provide that information in the designated field.
5. Input the employer’s Federal Employer Identification Number (FEIN) and a contact phone number for immediate reference.
6. Enter the policy period, including the start and end dates, ensuring that these align with the coverage details.
7. Complete the employee section: provide their legal name, date of birth, address, and social security number.
8. State the occupation or job title of the employee, followed by their employment status (choose whether it is unknown, full-time, part-time, etc.).
9. Document the date and time of the injury or illness, as well as the type and cause of the injury. Describe specifics about how the incident occurred.
10. If there were any witnesses, include their names and contact information for future reference.
11. Indicate whether safeguards or safety equipment were provided and if they were used during the incident.
12. After completing all required sections, carefully review the form for accuracy before saving the changes.
13. You may choose to download, print, or share the completed form as needed.

Complete your reports online today for efficient processing.