Get Iwcc Case Docket

Completing the Iwcc Case Docket online is a straightforward process that requires careful attention to detail. This guide aims to assist users in accurately filling out the form by providing step-by-step instructions for each section.

Follow the steps to complete the Iwcc Case Docket with ease.

1. Press the ‘Get Form’ button to access the form and open it in a suitable online editor.
2. Begin by entering the employer's FEIN in the designated field. This unique identifier is essential for the reporting process.
3. Fill in the date of the report to indicate when you are submitting the document.
4. Provide the case or file number, if applicable, to help categorize the report accurately.
5. Indicate whether this is a lost workday case by selecting 'Yes' or 'No'.
6. Input the employer's full name and any doing business as (DBA) name if different.
7. Fill in the employer's mailing address and email address for communication purposes.
8. Describe the nature of the business or service provided by the employer.
9. Enter the Standard Industry Classification (SIC) code related to the employer's business.
10. List the name of the workers' compensation carrier or administrator along with the policy or contract number.
11. Specify if the employer is self-insured by selecting 'Yes' or 'No'.
12. Complete the employee's full name and birthdate accurately.
13. Provide the employee's mailing address and email address for future correspondence.
14. Indicate the gender and marital status of the employee by selecting the appropriate options.
15. Enter the job title or occupation of the employee.
16. Record the time the employee began work and details about their hiring date.
17. Fill in the last day the employee worked and, if applicable, the date of death if the employee died due to the accident.
18. Specify whether the accident occurred on the employer's premises by selecting 'Yes' or 'No'.
19. Provide the address where the accident took place.
20. Describe what the employee was doing at the time of the accident.
21. Explain how the accident occurred in detail.
22. Detail the injury or illness sustained and specify which parts of the body were affected.
23. Identify any object or substance that directly caused harm to the employee.
24. List the name and address of the physician or healthcare professional involved.
25. If treatment was provided away from the worksite, include the name and address of that facility.
26. Select 'Yes' or 'No' to indicate if the employee was treated in an emergency room.
27. Indicate if the employee was hospitalized overnight as an inpatient.
28. Ensure to add the report preparer's signature, title, and telephone number.
29. Finally, review the entire form for accuracy, then save your changes, and choose to download, print, or share the completed document as necessary.

Start completing your documents online for a more efficient process.