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01. Edit your pinnacol assurance first report of injury online
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02. Sign it in a few clicks
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03. Share your form with others
Send pinnacol assurance first report of injury form via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out information pinnacol with our platform
- Click ‘Get Form’ to open the information pinnacol in the editor.
- Begin by filling out the POLICY INFORMATION section. Enter the Policy Number, Company Name, and any alternate address if applicable. Ensure all details are printed clearly.
- Proceed to the INJURED WORKER INFORMATION section. Fill in the injured worker’s Social Security Number, Date of Injury, and personal details such as First Name, Last Name, and contact information.
- In the ACCIDENT / INJURY INFORMATION section, indicate whether it was a fatal injury and provide details about the accident location and how it occurred. Be specific about the equipment used and body parts injured.
- Complete the RETURN TO WORK INFORMATION section by indicating if the injured worker has returned to work and providing an estimated return date if applicable.
- Finally, review all entered information for accuracy before submitting your form through our platform.
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