First Report Injury Form. Web employer's first report of injury. Home phone ( ) 5.
Employee Injury Report
In all other cases, report the injury to your employer. Name (last, first, m.i.) 2. Web this form quickly to allow your insurer time to investigate the claim. Home phone ( ) 5. Web employer's first report of injury. Web you may file your first report of injury (form 101), your monthly payment reports (form 107) and a request for extension of time online using the first report of injury management system. Web reporting an injury there's an injury, now what? Your insurer will report the injury to the department of labor and industry (department), when necessary. Department of labor (see instructions on reverse) office of workers' compensation programs omb no. How do i report an injury?
Web reporting an injury there's an injury, now what? Web this form quickly to allow your insurer time to investigate the claim. Home phone ( ) 5. In all other cases, report the injury to your employer. Department of labor (see instructions on reverse) office of workers' compensation programs omb no. Web employer's first report of injury. How do i report an injury? Web you may file your first report of injury (form 101), your monthly payment reports (form 107) and a request for extension of time online using the first report of injury management system. Your insurer will report the injury to the department of labor and industry (department), when necessary. Web reporting an injury there's an injury, now what? Name (last, first, m.i.) 2.
