Loading
Get Wy Dws Form Injrpt 2011-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the WY DWS Form INJRPT online
This guide provides a clear and supportive walkthrough for completing the WY DWS Form INJRPT online. The form is essential for reporting workplace injuries within Wyoming's workforce system.
Follow the steps to complete the WY DWS Form INJRPT effectively.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by providing the employer information in the designated fields. This includes the business name, work comp employer number, address, city, state, ZIP code, phone number, tax ID type, and tax ID number. Ensure you use black ink and avoid crossing zeros or sevens.
- Next, enter the employee information. Fill out fields for the employee's last name, first name, middle initial, mailing address, physical address (if different), phone number, email address, date of birth, date of hire, social security number, citizenship status, sex, marital status, and state of hire.
- Move on to the injury information section. Fill in the date and time of the injury, time the employee began work, date the employer was notified of the injury, last day of work after the injury, and type of employee. It's important to accurately disclose whether the injury occurred on employer premises.
- Provide details regarding medical treatment and lost time from work by checking the appropriate boxes and providing information about the physician or health care professional. Additionally, include the initial exam date.
- Complete the job description section. Clearly state the injured worker's detailed job title, typical duties performed at the time of the injury, and what happened during the incident, being specific about actions leading to the injury.
- Fill in the wage information. Indicate how the employee is paid (hourly, daily, weekly, etc.) and provide the respective rate. Complete the fields regarding work hours, overtime, and whether the employee was paid for the date of the accident.
- If necessary, authorize the Division of Workers’ Compensation to disclose or obtain information about the case. Ensure the employee or their representative signs the release field and date it accordingly.
- Complete the employer certification section, filling in the employer or supervisor's signature, name, title, and date. Carefully review all completed sections for accuracy.
- Once the form is completed, save your changes, and choose to download, print, or share the form as needed.
Start filling out the WY DWS Form INJRPT online now to efficiently report workplace injuries.
You should report any injuries that occur at work, regardless of severity. This includes minor injuries like cuts and bruises, as well as more significant injuries that require medical attention. Reporting these injuries ensures that they are documented and can assist you in filing a claim using the WY DWS Form INJRPT. It's vital to maintain transparent communication with your employer about any work-related injuries.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.