South Dakota Injury Report Form
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How to fill out Injury Report Form?
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FAQ
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.
You may file your First Report of Injury (Form 101), your Monthly Payment Reports (Form 107) and a Request for Extension of Time online using the First Report of Injury Management System.
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.
Mileage Rate effective Sept. 12, 2022 (only for travel to and from treatment): $0.51/mile.
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.
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 South Dakota Workers' Compensation Act provides that you have one year from the date of your accident to file a Notice of Claim. However, if you employer has provided medical treatment as a result of your job injury or if you are able to continue working following your injury, this deadline is extended.
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.