Employer's first report of injury form in Word and Pdf formats
1St Report Of Injury Form. Web employer's first report of injury or disease document number: Web employer's first report of injury.
Web if the claim involves death or serious injury (including injuries that later result in death), you must notify the department and your insurer within 48 hours of the occurrence. Fax a copy or mail the original to: Web employer's first report of injury. Web employer's first report of injury or disease document number: Web employer first report of injury form 1 (rev. 9/11) (approved for use as osha 101 and 301) state file no. State office of risk management. Department of labor (see instructions on reverse) office of workers' compensation programs omb no. Answer every question fully and report promptly to avoid.
Fax a copy or mail the original to: Fax a copy or mail the original to: Web employer's first report of injury or disease document number: Answer every question fully and report promptly to avoid. 9/11) (approved for use as osha 101 and 301) state file no. Web employer's first report of injury. Department of labor (see instructions on reverse) office of workers' compensation programs omb no. Web employer first report of injury form 1 (rev. State office of risk management. Web if the claim involves death or serious injury (including injuries that later result in death), you must notify the department and your insurer within 48 hours of the occurrence.
