Get Wi Wkc-12 2017-2025

The WI WKC-12, also known as the Employer's First Report of Injury or Disease, is a crucial document for reporting workplace injuries in Wisconsin. This guide will walk you through each section of the form, providing clear and supportive instructions to help you complete it accurately online.

Follow the steps to fill out the WI WKC-12 online.

1. Click the 'Get Form' button to obtain the WI WKC-12 form and open it in your browser for editing.
2. Fill out the employee information section by providing the name, birthdate, social security number, address, and contact details of the person who experienced the injury.
3. Complete the employer information section. Include your company's name, mailing address, city, state, zip code, employer FEIN, and the worker's compensation insurance carrier information.
4. In the wage information section, detail the employee’s wage at the time of injury, including hourly, weekly, monthly, or yearly rates. Indicate if overtime is applicable and list any additional benefits received, such as meals or tips.
5. Provide detailed injury information, including the date and time of the injury, the last day worked, and any medical treatment received. Clearly describe the nature of the injury and any tools or substances involved.
6. Complete any mandatory information fields as indicated on the form, ensuring all sections are filled accurately to prevent delays in processing.
7. After filling out the entire form, review all entries for accuracy and completeness. Make any necessary adjustments.
8. Save any changes, then proceed to download, print, or share the completed form. Ensure the report is sent to the employer’s insurance carrier or third-party administrator promptly.

Start completing the WI WKC-12 online today to ensure timely reporting of workplace injuries.