Get 18006999916

This guide provides a comprehensive approach to completing the 18006999916 form online. By following these steps, users can efficiently gather and input the necessary information for a workers' compensation claim.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to retrieve the form and open it in your editor.
2. Begin filling out the location code and date of accident. Ensure that the state is accurately selected and the employer's FEIN number is provided.
3. Input the employer's name and their phone number with the area code. Provide the name and mailing address of the preparer, including their title and the nature of the business.
4. State the policy number and complete the employee's full name, including their date of birth and social security number. Indicate the employee's marital status.
5. Add details regarding the employee's regular department, hire date, and duration of employment. Note the employee’s age and sex.
6. Provide the date the injury was reported to the employer and a description of the injury or illness sustained. Indicate any estimated or actual days off work.
7. Specify the employment status of the employee (e.g., full-time, part-time). Include wage class, daily and hourly wage information, and average weekly wage.
8. Complete the general injury information section, detailing the accident location and describing the nature of the injury or disease. Note any factors that could prevent future incidents.
9. Gather witness names and doctor details, noting any hospitalization information and whether the employee received pay while injured.
10. Review all filled-in details for accuracy. Use the options available to save changes, download, print, or share the completed form as necessary.

Complete your documents online today for a streamlined submission process.