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Click ‘Get Form’ to open the Georgia Form Worker in the editor.
Begin by filling out Section A, which includes identifying information about the employee. Enter the employee's last name, first name, middle initial, and date of injury. Select the gender and provide the birthdate, phone number, email, and mailing address.
Next, complete the employer section by entering the employer's name, mailing address, phone number, and NAICS code. Ensure that you include the nature of business and employer FEIN.
In Section B, provide details regarding employment and wage information. Fill in the wage rate at the time of injury or disease and indicate how many days per week were normally worked.
Proceed to Section C for injury/illness details. Specify if the injury occurred on employer premises and describe how it happened. Include treating physician information and any initial treatment given.
Finally, review all sections for accuracy before submitting your completed form to ensure compliance with submission guidelines.
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Forms | State Board of Workers Compensation - Georgia.gov
The Georgia State Board of Workers Compensation provides all forms, upon request, free of charge. To request paper copies of forms, please call (404) 656-3870.Read more
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