Get Hi 1c-p-526 2007-2025

Filling out the HI 1C-P-526 form is an important step in documenting your claim related to an incident. This guide provides clear and supportive instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the HI 1C-P-526 online.

1. Press the ‘Get Form’ button to access the HI 1C-P-526 form and open it in your preferred digital format.
2. Begin by providing your full name, current address, and date of birth in the designated fields. This information establishes your identity and contact details.
3. In the next section, list your occupation or job title along with the names and addresses of your employers for the last five years. Start with your current employer.
4. Describe, in detail, how the incident occurred. Include all relevant events from the five minutes leading up to the incident to provide a comprehensive account.
5. Indicate any contributing factors to your slip, trip, or fall. Break this down into the specified categories, such as slipperiness, defects, or obstructions, and provide specific details for each.
6. If you were wearing footwear at the time of the incident, provide the type and brand of the shoes, where and when they were purchased, the material of the sole, and the height of the heel.
7. Detail any prior reports made regarding the condition of the area where the incident occurred, including to whom the report was made.
8. List the names and addresses of all witnesses to the incident, including any description if you do not know their names.
9. If you made statements about the incident to authorities or others, provide their names, addresses, and employers, along with the date and nature of the statements.
10. Document any knowledge of photographs or sketches of the incident area, including the custodian of these documents.
11. State all physical and mental injuries you claim occurred as a result of the incident, as well as any pre-existing conditions you had before the incident.
12. List any injuries incurred after the incident that you believe either aggravated previous injuries or were new injuries.
13. Provide information about all healthcare providers you have seen in the last ten years for injuries related to the incident.
14. Detail all medical or healthcare expenses incurred as a result of the incident.
15. Identify any insurance carriers that provide medical or healthcare benefits relevant to your claim.
16. If applicable, state the periods of time you were off work due to the incident, your employer's name, your rate of pay, and the total loss of earnings.
17. Conclude by stating any anticipated future loss of earnings due to the incident.
18. Once all fields are completed, review your entries for accuracy, then save your changes, and proceed to download, print, or share the completed form as needed.

Take the necessary steps to complete your HI 1C-P-526 form online today.