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Click ‘Get Form’ to open the Employer’s First Report of Injury in the editor.
Begin by entering the employee's name in the designated field. Ensure you include the last name, first name, and middle initial for clarity.
Fill in the home telephone number and address accurately. This information is crucial for communication regarding the injury report.
Provide the employee's Social Security Number and native language code. If applicable, select marital status from the options provided.
Complete sections related to employment details, including average weekly wage, employer’s name, and address. Make sure all entries are legible.
Document injury specifics such as date of injury, location, and a brief description of how it occurred. This section is vital for processing claims.
Finally, ensure that all required signatures are obtained before submitting the form to avoid penalties.

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

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