Maine Injury Report Form
Description
How to fill out Injury Report Form?
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FAQ
All employers must keep a record of any reportable injury, an injury that leaves a worker incapacitated for over three days, disease, or dangerous occurrence. Your records must include: the date and method of reporting.
The employer is required to file an Employer's First Report of Injury or Illness [DWC FORM-001 Rev. 10/05] with the injured worker's insurance carrier, and the injured claimant or the claimant's representative within 8 days after the employee's absence from work or receipt of notice of occupational disease.
After 7 days of missed work due to your injury, you are entitled to receive weekly compensation benefits beginning on the 8th day. If you miss more than 14 days of work, you will then receive payment retroactive to the original date of injury.
Your employer will pay you 2/3 of your average weekly wage. This is called your compensation rate. There is a limit on how much you can receive, and the limit is different for different dates of injury.
If you're the one who discovers the incident, or you have been involved in the situation leading up to it and know more about it than your colleagues, filling out an incident report is your responsibility.
An Incident Report form might be completed by the staff involved in the incident that occurred or it might be completed by a safety manager on their behalf. See more on how to write an incident report. Incident reporting is the process of recording worksite events, including near misses, injuries, and accidents.
Every physician who treats an injured employee must file a complete Form 5021 Doctor's First Report of Occupational Illness or Injury (DFR) with the employer's claims administrator within five days of the initial examination.
