Get Workers Compensation Employer's First Report Of ...

Filling out the Workers Compensation Employer's First Report of Injury or Illness online is an essential step for employers when an employee is injured or becomes ill due to workplace conditions. This guide provides straightforward instructions to help you accurately complete the necessary form.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the employer's name and address, including the zip code, in the designated fields. Ensure that all information is accurate and up-to-date.
3. Fill in the claims administrator's name and contact information, including the claim number and jurisdiction, if applicable.
4. Provide the insured report number and location number, if these differ from the employer's main address. This information aids in claim identification.
5. Input the employee's information, including their name, date of birth, social security number, and date hired. Make sure all data is complete to assist with the assessment process.
6. Document details regarding the injury or illness, including the date and time it occurred, the last date worked, and any other relevant specifics pertaining to the incident.
7. Describe the event that led to the injury or illness, including any equipment or substances involved, and the specific activities the employee was engaged in at that time.
8. Complete the medical information section with details about the injured employee's healthcare provider, including the name and address of the physician and the hospital where treatment was received.
9. Confirm whether safety equipment was provided and if it was used during the incident. This information is vital for assessing safety practices.
10. Indicate any witnesses to the incident, along with their contact information, as this may support the claims process.
11. Once you have reviewed all entries for accuracy, save your changes. You will then have the option to download, print, or share the form as necessary.

Complete your documents online to ensure timely processing of workers' compensation claims.