Get Mn Fr01 2012-2025

The MN FR01 form, also known as the First Report of Injury, is a crucial document used to report work-related injuries, ensuring that employees receive the benefits they are entitled to. This guide provides clear, step-by-step instructions on how to accurately complete the form online, making the process manageable for all users.

Follow the steps to successfully complete the MN FR01 form online.

1. Click the ‘Get Form’ button to access the document and open it in your browser.
2. Provide the employee's Social Security number in the designated field, ensuring accuracy to avoid processing delays.
3. Fill in the OSHA case number if applicable; this can be found in the OSHA 300 log.
4. Enter the date of the claimed injury and the time when the injury occurred, specifying AM or PM accurately.
5. Record the time the employee began work on the date of the injury, noting the AM/PM distinction.
6. In the next section, enter the full name of the employee along with their gender.
7. Complete the home address of the employee, including city, state, and zip code.
8. Indicate the average weekly wage and rate per hour for the employee, ensuring accuracy in wage documentation.
9. Detail the number of dependents if the injury is a result of a death due to the incident.
10. Provide a clear account of how the injury or illness occurred in the specified section, including details of the nature of the injury.
11. Document the specific injury sustained, including the affected body parts.
12. Identify any tools, equipment, or substances involved in the incident.
13. Confirm whether the injury occurred on the employer's premises.
14. Record the first date of any lost time as it relates to the injury, regardless of any payment provided by the employer.
15. Indicate if the employer covered lost time for the day of the injury.
16. Note the date the employer was first notified of the injury and the date of any lost time.
17. Input the return to work date where applicable and confirm if the person returned to the same employer.
18. Complete the information related to medical treatment, including details on the level of care received.
19. Fill in the employer's legal name, DBA name, mailing address, and contact information.
20. Provide the insurer's details, including name and address if applicable.
21. Before finalizing the form, review all the inputted information for completeness and accuracy.
22. Once reviewed, users can save changes, download, or print the completed form for submission to the appropriate parties.

Complete all necessary documents online to ensure timely submission and processing of your claim.