Missouri Report of Injury

State:
Missouri
Control #:
MO-SKU-2206
Format:
PDF
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Description

Report of Injury The Missouri Report of Injury (Form 5020) is a document which is used to report work-related injuries or illnesses that occur in the state of Missouri. This form must be completed by the employer, or their representative, and submitted to the Missouri Division of Workers’ CompensationMDCWC). This form is used to notify the MDC of the work-related injury or illness, and to provide information about the injured worker, the employer, and the facts surrounding the injury or illness. There are two types of Missouri Report of Injury: the Employer's First Report of Injury (Form 5020) and the Employer's Supplementary Report of Injury (Form 5020A). The Employer's First Report of Injury (Form 5020) is used to report the details of the injury or illness, and is generally completed on the day the injury or illness occurs. The Employer's Supplementary Report of Injury (Form 5020A) is used to update the information on the original report. This form is generally completed when there is a change in the status of the injury, such as the worker returning to work or a payment of workers’ compensation benefits being made.

The Missouri Report of Injury (Form 5020) is a document which is used to report work-related injuries or illnesses that occur in the state of Missouri. This form must be completed by the employer, or their representative, and submitted to the Missouri Division of Workers’ CompensationMDCWC). This form is used to notify the MDC of the work-related injury or illness, and to provide information about the injured worker, the employer, and the facts surrounding the injury or illness. There are two types of Missouri Report of Injury: the Employer's First Report of Injury (Form 5020) and the Employer's Supplementary Report of Injury (Form 5020A). The Employer's First Report of Injury (Form 5020) is used to report the details of the injury or illness, and is generally completed on the day the injury or illness occurs. The Employer's Supplementary Report of Injury (Form 5020A) is used to update the information on the original report. This form is generally completed when there is a change in the status of the injury, such as the worker returning to work or a payment of workers’ compensation benefits being made.

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Missouri Report of Injury