Ny wcd form 2025

1. Click ‘Get Form’ to open the ny wcd form in the editor.
2. Begin by entering the full name of the injured person in the designated fields for first, middle, and last names.
3. Fill in the address, home telephone number, business telephone number, social security number, and date of birth in their respective sections.
4. Provide the name of the employer and the department where the injured person works.
5. Record the date and hour of the accident, ensuring to specify AM or PM.
6. Describe the exact location of where the accident occurred clearly and concisely.
7. Detail how the accident happened in the provided space, ensuring a thorough explanation.
8. Indicate the nature and extent of injury sustained by filling out that section accurately.
9. Confirm whether you informed your supervisor about the accident and provide their name along with the date you reported it.
10. List any witnesses' names and addresses as required at the end of the form.
11. Finally, sign and date at the bottom to complete your notice. Remember, this is not a claim form; a separate claim form can be obtained from any office of the State Workers’ Compensation Board.

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