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Click ‘Get Form’ to open the Employer’s First Report of Injury in the editor.
Begin by filling in the employee's details, including their name, home telephone number, and address. Ensure all information is printed legibly or typed.
Provide the employee's Social Security Number and select their native language code from the options provided.
Complete sections regarding the employer's information, including name, address, and contact details. Be sure to include the industry code as indicated on the form.
Detail the injury information by entering the date of injury, location, and a brief description of how it occurred. Include any witnesses if applicable.
Finally, ensure that all preparer's information is filled out accurately before submitting. Review for completeness to avoid delays.

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Versions	Form popularity	Fillable & printable
2013	4 Satisfied (46 Votes)
2001	4.8 Satisfied (288 Votes)

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