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Workers Compensation Report r4 indd

Workers Compensation Report r4 indd 2026

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The document is a Workers' Compensation Injury/Illness Report form that must be completed by the supervisor or medic of an injured employee. It collects essential information about the employee, injury details, accident site, medical attention sought, and witness accounts. The form is intended for reporting injuries or illnesses occurring during work and includes instructions for submission to Cast & Crew Entertainment Services.

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Click ‘Get Form’ to open the Workers Compensation Report r4 indd in the editor.
Begin by filling out the required employee information, including the employee's name, date of injury, and production/event details. Ensure all fields marked with an asterisk (*) are completed.
In the accident information section, provide a detailed description of how the injury occurred. Select appropriate options from dropdown menus for cause and nature of injury.
Complete the accident site information by entering the address where the injury occurred, along with city, state, and zip code.
Fill out medical facility information if applicable. Indicate whether medical attention was sought and provide details about the physician and facility.
If there were witnesses, record their names and contact information in the witness information section.
Finally, review all entries for accuracy before submitting via email or fax as instructed at the bottom of the form.

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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.

What is section 49 of the Workers Compensation Act?

Section 49 of the Workers Compensation Act 1987 (NSW) enables injured workers to receive compensation payments for their injuries even when they have already accrued benefits, such as annual leave, which they could use to recover from their injury.

What is Section 4 of the Employees compensation Act?

(4) If the injury of the *[employee] results in his death, the employer shall, in addition to the compensation under sub-section (1), deposit with the Commissioner a sum of *[not less than five thousand rupees] for payment of the same to the eldest surviving dependant of the *[employee] towards the expenditure of the

What is the s4 of the Workers Compensation Act?

s 4 , Workers Compensation Act 1987 Injury: means personal injury arising out of or in the course of employment, includes a disease injury, which means: a disease that is contracted by a worker in the course of employment but only if the employment was the main contributing factor to contracting the disease, and.

What is the most common workers compensation claim?

Common Causes of Workers Compensation Claims Strains and Sprains. Strains and sprains are by far the most common on-the-job injury for workers. Cuts and Punctures. Severe Cuts and Lacerations. Overuse or Repetitive Stress Injuries, Including Back Injuries. Fractures.

What is a PR4 in workers comp?

PRIMARY TREATING PHYSICIANS PERMANENT AND STATIONARY REPORT(PR-4) This form is required to be used for ratings prepared pursuant to the 2005 Permanent Disability Rating Schedule and the AMA Guides to the Evaluation of Permanent Impairment (5th Ed.).

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What is the part four of a workers compensation policy?

Part four your duties if injury occurs notify the insurer at once, provide immediate medical services, assist the insurer in investigating, settling or defending a claim, and promptly forward all notices demand or legal papers.