Wkc 12: Fill out & sign online

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01. Edit your wkc 12 online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

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03. Share your form with others

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Click ‘Get Form’ to open the wkc 12 in the editor.
Begin by filling out the Employee Section. Enter the employee's name, birthdate, and Social Security Number (optional). Ensure all details are accurate to avoid processing delays.
Next, complete the Employer Section. Provide your company's name, address, and Federal Employer Identification Number (FEIN). If applicable, include information about your worker’s compensation insurance carrier.
In the Wage Information Section, specify the employee's wage at the time of injury. Indicate whether they receive overtime pay and detail any additional compensation such as meals or tips.
Proceed to the Injury Information Section. Document the date and time of injury, a detailed description of what occurred, and any medical treatment received. This section is crucial for accurate claims processing.
Finally, ensure that you sign and date the report before submitting it electronically through our platform for timely processing.

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