Report workers form 2026

1. Click ‘Get Form’ to open the report workers form in the editor.
2. Begin by entering the WC Claim Number, Employee Name, Birth Date, and Social Security Number in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the Employer Name and Date of Accident or First Illness. This section helps establish the context of the claim.
4. Complete the Highest Level of Formal Education Completed and any Vocational Education or Training. This information assists in evaluating employability.
5. List Previous Employment details including Employer Name, Mailing Address, Job Duties, and Date Hired. Repeat for additional employment history as necessary.
6. Detail any special skills affecting employability and preexisting physical or mental limitations that may impact work capabilities.
7. Provide information regarding Nature of Injury, any surgeries performed, and resulting limitations based on medical opinions.
8. Indicate Weekly Wage at time of injury and Present Wage for comparable work. This will help assess financial impacts due to injury.
9. Identify types of employment currently available considering age, education, work history, and limitations. Include pay rates for these jobs if applicable.
10. Finally, provide your expert qualifications and signature at the end of the form to validate your assessment.

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