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Employer s First Report of Injury 2026
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How to Use or Fill Out the Employer’s First Report of Injury Form Online
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the name of the injured employee in the designated fields for Last and First names.
- Fill in the Social Security Number (SSN) and Date of Birth, ensuring accuracy for proper identification.
- Select the sex of the employee by checking either 'M' for Male or 'F' for Female.
- Complete the Employee Mailing Address section with accurate details including street, city, state, and zip code.
- Provide contact information by filling out both home and cell phone numbers.
- Indicate work hours by specifying the time range from 'From' to 'To', along with normal scheduled days off.
- Enter job title/job code and employment status (Part Time or Full Time).
- Continue filling out agency details, date of injury, time of injury, and whether the incident occurred on agency premises.
- Finally, describe the accident circumstances and injuries sustained in detail. Ensure all witness information is included if applicable.
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Related links
A work-related injury or illness must be reported within 10 days (Per Section 110) of the injury/illness or be subject to a penalty. Employers are notRead more
Describe in detail how and why the injury, illness, or death occurred (Include the events leading up to the injury or illness, state the actual injury,Read more