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Nh report injury 2026
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- Click ‘Get Form’ to open the nh report injury in the editor.
- Begin by filling out the ***EMPLOYEE INFORMATION*** section. Enter the employee's full name, gender, and ID type. Include their date of birth, address, telephone number, hire date, occupation at the time of injury, age, hours worked per day, wages per hour, days worked per week, and average weekly earnings.
- Next, move to the ***INJURY INFORMATION*** section. Document the date you were notified of the injury and the actual date and time of the incident. Specify the location/job site where it occurred and provide a detailed accident description along with information about any witnesses.
- Complete the ***EMPLOYER INFORMATION*** section by entering your employer's name, FEIN, contact details, industry code, and business address.
- Fill in the ***INSURER INFORMATION*** with details about the insurance carrier including policy number and contact number.
- Finally, complete the ***SUBMITTER INFORMATION*** section with your name, title, and contact information before submitting via email or fax as indicated.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2019 | 4.9 Satisfied (22 Votes) |
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