Form 101 pdf 2025

Show details

4.8 out of 5

288 votes

The document is the Employer's First Report of Injury or Fatality (Form 101) required by the Commonwealth of Massachusetts for employers to report workplace injuries that result in death or incapacity lasting five or more calendar days. It includes sections for employee and employer information, details about the injury, and filing instructions. The form must be submitted within seven days of notification of an injury and is not an admission of liability.

Here's how it works

01. Edit your form 101 pdf online

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

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send form 101 via email, link, or fax. You can also download it, export it or print it out.

The best way to change Form 101 pdf online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making adjustments to your paperwork requires only a few simple clicks. Make these quick steps to change the PDF Form 101 pdf online free of charge:

Register and log in to your account. Sign in to the editor using your credentials or click on Create free account to evaluate the tool’s features.
Add the Form 101 pdf for redacting. Click on the New Document button above, then drag and drop the sample to the upload area, import it from the cloud, or using a link.
Alter your template. Make any adjustments needed: insert text and images to your Form 101 pdf, highlight details that matter, erase sections of content and substitute them with new ones, and add symbols, checkmarks, and areas for filling out.
Finish redacting the form. Save the modified document on your device, export it to the cloud, print it right from the editor, or share it with all the parties involved.

Our editor is very user-friendly and effective. Try it now!

See more form 101 pdf versions

We've got more versions of the form 101 pdf form. Select the right form 101 pdf version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2013	4 Satisfied (46 Votes)
2001	4.8 Satisfied (288 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How can I eSign my [KEY] from Gmail?

With DocHub, it’s pretty simple. The service offers users an add-on called DocHub for Gmail, which you can find in the Google Workspace Marketplace without being charged. Set it up and give it access to your Google account. Open your email with your [KEY] attached and click on the add-on button in the right-side panel. Sign in to your DocHub account, and upload the form to our editor, where you can fill it out and sign.

How do you get [KEY] for my state?

If you are looking for a state-specific [KEY] sample, you can find it in our DocHub Forms & Templates catalog. Use the search field, key in your form’s name, and search through the results for your state. You may also filter out irrelevant results while browsing our catalog by groups.

Is a Compromise and release settlement taxable?

Workers' compensation benefits are not taxable. This includes payments an injured worker receives in a Compromise and Release workers' compensation settlement.

How long does it take for Ouac to process acceptance?

Note: It may take 1-3 business days to process your response. Important: Watch the instructional video on how to respond to your offer of admission.

What is a QME appointment notification form?

QME Form 110 (rev. February 2009) QME APPOINTMENT NOTIFICATION FORM. To the Qualified Medical Evaluator: You are required by law to give notice on this form when an appointment has been made with you to perform a QME comprehensive medical evaluation. Please complete this form in its entirety.

101 form

Official Form 121 Official Form 103A Official Form 106A/B Form 122A-1 instructions Voluntary Petition Chapter 7 Official Form 106Sum How to fill out Form 106C Form 107

Can I accept two university offers Ouac?

Yes. If you accept an offer but later wish to accept a different offer, you will need to first cancel your accepted offer and then accept the new offer by the stipulated deadline date.

What happens at a QME appointment?

In addition to asking questions about your medical history and workplace injury, the doctor will perform a physical exam and fill out a report with his or her findings.

What is the purpose of a QME?

Qualified medical evaluator process. Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers' Compensation - Medical Unit to examine injured workers to evaluate disability and write medical-legal reports.

How many programs can I apply to on Ouac?

You may apply to as many Ontario universities as you wish; however, you are limited to a maximum of 3 program choices at any 1 university (including affiliates). Some universities may further limit the number of programs you can apply to.

Is there a time limit to report an accident at work?

3 years from the date of the workplace accident that left you suffering from injuries whether minor or more severe. 3 years from the time you turn 18 years old if the workplace accident happened prior to your 18th This means you must file a claim before you are 21 years old.