Get Workers&#39 Compensation

Completing the Workers’ Compensation form is an important step in reporting an injury or illness sustained in the workplace. This guide will provide clear instructions on how to accurately fill out each section of the form online, ensuring that all necessary information is captured.

Follow the steps to complete the Workers’ Compensation form successfully.

1. Click the ‘Get Form’ button to access the Workers’ Compensation form and open it in the online platform.
2. Enter your name in the designated field to identify yourself as the injured employee.
3. Input your ID number assigned by your employer to ensure proper identification.
4. Fill in the department name where you work to provide context for the report.
5. Specify the date of the accident, which is crucial for record-keeping.
6. Provide your office location to help pinpoint where the incident occurred.
7. Indicate the time of the accident to give a clearer timeline of events.
8. Include your office phone number so that you can be easily contacted for follow-up.
9. Describe the place where the accident took place, providing details that may affect the investigation.
10. Write a detailed account of the accident, including the cause of the injury, to give context for the claim.
11. Specify the part of the body that was affected to assist medical professionals and claims processors.
12. Document the nature of the injury or illness that occurred as a result of the accident.
13. Sign the form as the injured employee to verify that all provided information is accurate.
14. The supervisor should then complete their section, including their name and signature.
15. The supervisor must indicate whether they agree with the employee’s description of the accident by checking 'Yes' or 'No.'
16. Provide the office phone number of the supervisor for further communication.
17. Input the supervisor’s office location, including the building and room number, to ensure clarity in reporting.
18. Review the completed form for accuracy before submitting.
19. Keep a copy of the completed form for your records, and send the original to the Human Resources Department at ADM 114.

Complete your Workers’ Compensation report online today to ensure timely processing of your claim.