Incident Investigation First Report of Injury - CAPS Payroll 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Injured Worker Information section. Enter the worker's name, Social Security number, address, and contact details. Ensure accuracy as this information is crucial for processing.
3. Next, complete the Date of Injury and Time of Injury fields. This information should be recorded as soon as possible after the incident.
4. In the Medical Provider Information section, provide details about the treating clinic or hospital. Indicate whether an ambulance was called and if additional treatment is required.
5. Fill out the Accident Location section with precise details about where the incident occurred, including weather conditions and witness information.
6. Injury Investigation requires a detailed description of how the injury occurred. Be thorough in documenting nature of injury and any direct causes.
7. Finally, complete the Person Completing Form section with your name, title, phone number, signature, and date to validate the report.

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