Injury report form 2025

See details

4 out of 5

27 votes

The document is a form from the State of Connecticut Workers' Compensation Commission, specifically the Employer's First Report of Occupational Injury or Illness. It is intended for employers to report workplace injuries or illnesses that result in an employee's incapacity for one day or more. The form requires detailed information about the employer, employee, injury details, and treatment received.

Here's how it works

01. Edit your injury report format online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send work accident injury report forms via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out injury report form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the injury report form in the editor.
Begin by entering the employer's information, including name, address, and phone number. Ensure all details are accurate for proper processing.
Fill in the employee's personal details such as last name, first name, date of birth, and contact information. This section is crucial for identifying the individual involved.
Document the specifics of the injury or illness by providing the date it occurred, location, and a detailed description of how it happened. This helps in understanding the context of the incident.
Indicate whether safety equipment was provided and used during the incident. This information is vital for compliance and future safety measures.
Complete any additional sections regarding medical treatment received and notify dates. This ensures that all necessary follow-up actions are documented.

Start filling out your injury report form today using our platform for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do you write an injury report?

How to write a workplace incident report Gather essential information. Describe the incident. Include injuries and damages. Interview witnesses. Identify contributing factors. Review company policies and procedures. Attach supporting documents. Maintain objectivity.

What not to say to a workers comp doctor?

What You Shouldnt Tell Your Workers Comp Doctor Never lie about prior injuries, pre-existing conditions, or medical history. Never lie about the extent of your workplace injury or how it happened. Do not exaggerate your symptoms, including pain or functionality.

What is a DWC 7 form?

Workers Compensation Claim Form (DWC-7) Form DWC-7 is a notice to provide injured workers with rights, benefits and contact information. DOWNLOAD DWC-7 FORM.

How do I create an accident report form?

Accident report forms should include fields for names and contact information of the individuals and witnesses involved, the type of accident, the date and time the accident occurred, the location of the accident, a detailed description of the accident, and room for any additional comments.

What is the DWC in workers comp?

The Division of Workers Compensation (DWC) monitors the administration of workers compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers compensation benefits.

What is the DWC 7 form?

DWC-7 Notice to Employees-Injuries Caused by Work (English and Spanish). This form provides your employees with information regarding workers compensation benefits and the Medical Provider Network (MPN) in California.

What is a DWC form in Texas?

Form DWC-1 Employers First Report of Injury or Occupational Disease. The employer is required to submit this form with EMPLOYERS and the injured employee or the injured employees attorney within eight days after the employees absence from work or notice of the Injury or Occupational Disease.

What are the OSHA requirements for injury reporting?

As required by Title 8 regulations, section 342, you must include the following information in your phone call, if available: Time and date of accident/event. Employers name, address and telephone number. Name and job title of the person reporting the accident. Address of accident/event site.

Injury report form 2025

Here's how it works