Employee injury report form

• [DOC File]WKC-12-E, Employer's First Report of Injury or Disease

  https://info.5y1.org/employee-injury-report-form_1_5c9d2b.html

  This form is for the employer to report every work-related injury to its insurance company. If an employee is out more than 3 days due to a work-related injury, or there is PPD, a copy is to be sent to the …

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• [DOC File]First Report of Injury Form

  https://info.5y1.org/employee-injury-report-form_1_e3179a.html

  Provide copies to Admin and your injured worker. If the claim results in the employee’s inability to work for a period of more than three days, send a copy of this report to the employee’s local union office. Fill in all the information you can, except items 46-54. Form Instructions. Employee …

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• Form OIC-WC-1

  What was the Employee Doing when Injury Occurred (loading truck, walking down stairs, etc.): How did the Injury or Disease Occur (be specific; include time that employee began work on the date of injury, …

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• [DOC File]DOA-6058 Employee Workplace Injury or Illness Report

  https://info.5y1.org/employee-injury-report-form_1_7e342f.html

  Guidelines for Completing DOA-6058 Employee’s Workplace Injury or Illness Report. Employees Instructions for filling out this report. Notify your Supervisor and/or Agency's Worker's Compensation …

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• [DOC File]REPORT TO BE FILLED OUT BY EMPLOYEE

  https://info.5y1.org/employee-injury-report-form_1_6be69a.html

  supervisor’s report of employee’s report of. injury, exposure, or medical condition. complete and return 24 hours to: peter schlosser, fax: 287-2216 - email: peter.schlosser@maine.gov

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• [DOC File]REPORT TO BE FILLED OUT BY EMPLOYEE

  https://info.5y1.org/employee-injury-report-form_1_b42a46.html

  EMPLOYEE’S REPORT OF INJURY, EXPOSURE, or MEDICAL CONDITION. Complete and return within 24 hours to: PETER SCHLOSSER – peter.schlosser@maine.gov or Fax: 287-2216

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