Workers compensation claim form 2026

1. Click ‘Get Form’ to open the Workers’ Compensation Claim Form (DWC 1) in the editor.
2. Begin by completing the 'Employee' section. Fill in your name, home address, date of injury, and a description of where the injury occurred.
3. In the same section, describe the injury and specify which part of your body is affected. Ensure you include your Social Security Number.
4. Sign the form in the designated area to confirm that all information provided is accurate.
5. Once completed, keep a copy marked as 'Employee’s Temporary Receipt' and submit the rest to your employer for their completion.
6. Your employer will fill out their section and provide you with a dated copy. They must also send one copy to the claims administrator within one working day.

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