First Report of Injury - DHRM Utah Department of Human Resource - dhrm utah 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the employee's name, Social Security/EIN number, and title in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the home address and contact numbers, including home, work, and cell phone. This allows for easy communication regarding the incident.
4. Record the date of birth, assignment location, specific location of the incident, injury date, and time. This section helps establish context for the injury.
5. Provide a detailed description of the incident in the specified area. Be thorough to ensure all relevant details are captured.
6. Indicate treatment type by checking the appropriate box. If hospitalization or referral is needed, provide physician details.
7. Complete questions regarding work status post-injury and any previous injuries to the same body part. This information is vital for claims processing.
8. Finally, have the employee sign and date the form at the bottom to validate their report before submission.

Start using our platform today to streamline your document editing and form completion process!