Get Tennessee First Report Of Injury And Accident Report - Cdom

Filling out the Tennessee First Report Of Injury And Accident Report - Cdom is a crucial step in documenting workplace injuries or illnesses. This guide will provide you with clear instructions on how to complete the form efficiently and accurately online.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the jurisdiction claim number in the designated field. Make sure this number is correct as it will be used to track the claim.
3. Select the claim type code that corresponds to the situation. Options may include 'Med only,' 'Indemnity,' 'Became lost time,' 'Became med only,' 'Notify only,' and 'Transfer'.
4. Enter the details of the claims administrator or carrier, including their claim number, insurance carrier name, and any other required fields. This information ensures proper processing of the report.
5. Fill in the employer's information, including the Employer FEIN, name, address, and contact details. This section identifies who is reporting the injury.
6. Provide the employee’s personal information. This includes their last name, date of birth, social security number, gender, and marital status. These identifiers protect the privacy of the individual and ensure the correct information is attached to the claim.
7. Document the accident or injury details including the date and time of the incident, how the injury occurred, and the specific body parts affected. Be detailed in this section to provide a clear picture of the incident.
8. Record the physician’s name, any initial treatment received, and the location where the treatment was carried out. This information is necessary for follow-up and evaluation of the injury.
9. Complete any remaining fields related to employment status, number of days worked per week, and salary details. This information aids in determining entitlements related to workers' compensation.
10. Review all information entered to ensure accuracy. Once finalized, you can save changes, download the form for your records, print it, or share it as required.

Complete the Tennessee First Report Of Injury And Accident Report - Cdom online today to ensure compliance and facilitate prompt processing of your claim.