Get Employer’s Supplemental Report Of Injury
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How to fill out the Employer’s Supplemental Report Of Injury online
Filling out the Employer’s Supplemental Report of Injury online is an important process for employers reporting an employee's disability due to an occupational injury or disease. This guide provides clear, step-by-step instructions to help you accurately complete the form and meet the necessary filing requirements.
Follow the steps to accurately complete the report online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the employer's name in the designated field, followed by the Employer’s Identification Number, which is a 9-digit number assigned by the proper Federal Agency.
- Provide the complete address of the employer, including the street address, city, state, and zip code.
- Indicate the name of the insurance carrier insuring the employer against worker injuries in the relevant field.
- Enter the employee's name by filling in the first name, middle initial, and last name. Be sure to also provide the employee's Social Security Number.
- Fill in the employee's address, including the street address, city, state, and zip code.
- Record the date of the injury in the specified format.
- Indicate the date when the disability began, along with the time (A.M. or P.M.) of the day it started.
- If applicable, specify additional dates of disability in the provided space.
- Answer whether the injured employee has returned to work. If they have, provide the date and the hour of return (A.M. or P.M.).
- State whether the injured person is earning the same wages as before the injury. If they are not, provide an explanation in the designated area.
- Complete the report by providing the date of submission, signing the report, entering the official title, and indicating a contact telephone number.
- Once all information is entered, save changes, download, print, or share the completed form as needed.
Submit the Employer’s Supplemental Report of Injury online to ensure compliance and support your injured employee.
In Louisiana, the first report of injury serves as a formal document that outlines the details of a work-related injury, which is necessary for initiating benefits for the employee. Employers must submit this report promptly to ensure that the injured worker receives appropriate compensation and care. Properly completing this report can expedite the claims process. Integrating the Employer’s Supplemental Report Of Injury can help clarify any additional questions or concerns.
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