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Mn first report of injury

Minnesota report injury 2026

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The document is a form from the Minnesota Department of Labor and Industry for reporting workplace injuries under the Workers' Compensation Division. It outlines the necessary information employers must provide regarding an employee's injury, including personal details, circumstances of the injury, and employer responsibilities. The form emphasizes timely reporting to insurers and includes instructions for both employers and insurers on completing and submitting the report.

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Click ‘Get Form’ to open the Minnesota Report of Injury in the editor.
Begin by entering the employee's Social Security number and OSHA case number in the designated fields.
Fill in the date of the claimed injury and the time it occurred, ensuring you use the MM/DD/YYYY format.
Provide details about the employee, including their name, gender, marital status, home address, phone number, date of birth, and occupation.
In section 22, describe how the injury occurred. Be specific about what the employee was doing at that time.
Complete sections regarding medical treatment and employer information. Ensure all required fields are filled accurately.
Review all entries for accuracy before submitting. Use our platform’s features to save your progress or make edits as needed.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (21 Votes)
2012	4.3 Satisfied (168 Votes)

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