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4.9 out of 5

41 votes

DESCRIBE THE SEQUENCE OF EVENTS AND INCLUDE ANY OBJECTS OR SUBSTANCES THAT DIRECTLY INJURED THE EMPLOYEE OR MADE THE EMPLOYEE ILL CAUSE OF INJURY CODE DATE RETURN ED TO WORK IF FATAL GIVE DATE OF DEATH PHYSICIAN/HEALTH CARE PROVIDER NAME ADDRESS WERE SAFEGUARDS OR SAFETY EQUIPMENT PROVIDED WERE THEY USED HOSPITAL OR OFF SITE TREATMENT NAME ADDRESS INITIAL TREATMENT NO MEDICAL TREATMENT MINOR BY EMPLOYER MINOR CLINIC/HOSP EMERGENCY CARE HOSPITALIZED 24 HOURS FUTURE MAJOR MEDICAL/ LOST TIME ANTIC ...

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Versions	Form popularity	Fillable & printable
2002	4.9 Satisfied (41 Votes)
1993	4 Satisfied (44 Votes)

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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 long do you have to report an injury at work in California?

In California, a workplace injury must be reported within 30 days of the incident and a workers' compensation claim must be filed within one year. Simply stated, when it comes to filing forms for work-related injuries, the sooner the better.

What is the most common injury claim on workmans comp?

The 5 Most Common Workers' Compensation Injuries Strains (30.06% of workers' compensation claims) Contusions (20.83% of claims) Lacerations (11.79% of claims) Sprains (8.85% of claims) Punctures (5.50% of claims)

How long do you have to report a work injury in Florida?

How long after an accident occurs on the job do I have to report it to my employer? You should report the work-related accident as soon as possible but no later than thirty (30) days from the date the accident occurs, or within thirty (30) days of the date the doctor says you are suffering from a work-related injury.