Form c 1 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Employer' and 'Name of Employee' in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the 'Social Security Number' and 'Date of Accident'. If applicable, include the 'Time of Accident' and 'Telephone Number' for further communication.
4. In the section regarding the nature of the injury or occupational disease, provide a detailed description. List any body parts involved to give clarity on the incident.
5. Briefly describe the accident or circumstances surrounding the occupational disease. If claiming an occupational disease, indicate when you first recognized its connection to your employment.
6. Document any witnesses by entering their names in the provided field. This can support your claim if needed.
7. Answer questions about whether first aid was provided, if you left work due to the injury, and if you have returned to work. Provide dates and times where applicable.
8. Complete any additional questions regarding involvement of others and supervisor's signature at the end of the form.

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