Get Twcc1 Form

The Twcc1 Form is an essential document for reporting a work-related injury or illness. This guide provides clear and concise instructions for completing the form online, ensuring accuracy and compliance with necessary requirements.

Follow the steps to fill out the Twcc1 Form online

1. Press the ‘Get Form’ button to access the Twcc1 Form and open it in the designated editor.
2. In Section 1, enter the employee's full name (Last, First, M.I.) as it appears on their official documents.
3. Select the employee's sex by marking the appropriate option: Male or Female.
4. Provide the employee's Social Security Number for identification purposes.
5. Enter the employee's home phone number, including the area code.
6. Indicate whether the employee speaks English by selecting ‘Yes’ or ‘No’. If ‘No’, specify the language.
7. Fill in the employee's date of birth using the format month-day-year.
8. Record the date when lost time from work began, following the same date format.
9. Specify the time of injury, choosing between AM or PM.
10. Document the date of the injury, ensuring it reflects the exact date of occurrence.
11. List the nature of the injury in detail, using clear and specific descriptions.
12. Identify the part of the body that was injured or exposed, specifying if applicable left or right side.
13. Describe how and why the accident or injury occurred. Be thorough and provide as much detail as possible.
14. Fill in the worksite location of the injury, such as stairs or a dock.
15. Confirm whether the employee was performing their regular job at the time of injury by marking 'Yes' or 'No'.
16. Provide the employee's mailing address, including street, city, state, and zip code.
17. Enter marital status by selecting Married, Widowed, Divorced, Separated, or Single.
18. List the number of dependent children, if applicable.
19. Provide the spouse's name, if applicable, followed by the doctor's name and contact number.
20. List any witnesses to the incident, including their names and contact numbers.
21. Record the return to work date, or mark N/A if not applicable, in the required format.
22. Indicate the employee’s length of service in their current position and overall occupation.
23. Fill in the agency information, including name, address, and telephone number.
24. Review the entire form for accuracy and completion.
25. Once completed, save changes, then download, print, or share the Twcc1 Form as needed.

Complete your Twcc1 Form online today to ensure timely processing of your claim.