Get Ut Commission Form 122 2009-2025

Filling out the UT Commission Form 122 is an essential step for employers to report workplace injuries or illnesses. This guide will provide clear, step-by-step instructions to help you complete the form online with confidence.

Follow the steps to successfully complete the UT Commission Form 122 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the employer's information. In this section, include the employer's name, address, phone number, and FEIN (Federal Employer Identification Number).
3. Next, provide details regarding the carrier or claims administrator. Fill in the name, address, and phone number, as well as the policy period and claim number.
4. Proceed to the employee section. Input the employee's name, address, date of birth, social security number, and marital status. Ensure you also capture their occupation and employment status.
5. In the occurrence/treatment section, enter the time and date of the injury or illness. You must include details on whether the injury occurred on the employer's premises and any relevant additional information about the type of injury or illness.
6. Document the treatment information, including the hospital or physician's name, and indicate the type of initial treatment received by the employee.
7. Provide information about any witnesses to the incident and any safeguards or safety equipment that were provided and used at the time of the injury.
8. After entering all required details, review the form carefully to ensure accuracy and completeness. Save changes, download, print, or share the form as necessary.

Complete your UT Commission Form 122 online today to ensure timely reporting of workplace injuries.