Minnesota Injury Report Form
Description
How to fill out Injury Report Form?
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FAQ
Filing a first report of injury (FROI)
The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid*.
All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.
Regardless of your company's own policies, under Minnesota Workers' Compensation law, you are required to report your injury within 30 days of the injury. Only in limited circumstances are you allowed to report your injury beyond 30 days. 2. Seek medical care or treatment.
If you are injured at work, or have a work-related illness: Immediately report any work-related injury to your supervisor. If you require emergency medical treatment, obtain care first, and then notify your supervisor as soon as possible after receiving treatment.
Medical care must be paid for by your employer if you get hurt on the job ? whether or not you miss time from work. You may be eligible to receive benefits even if you are a temporary or part-time worker.
Your employer is required to fill out a form, sometimes called a "First Report of Injury," for every injury which occurs in the workplace. Make sure that your employer fills out a form for you. Review the form to make sure that it is accurate, and request that you be provided with a copy for your own records.
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.