Form Ia1 Workers Compensation First Report Of Injury Or Illness
First Report Injury Form. Your insurer will report the injury to the department of labor and industry (department), when necessary. Home phone ( ) 5.
Form Ia1 Workers Compensation First Report Of Injury Or Illness
Name (last, first, m.i.) 2. Web this form quickly to allow your insurer time to investigate the claim. How do i report an injury? In all other cases, report the injury to your employer. Home phone ( ) 5. Web reporting an injury there's an injury, now what? Department of labor (see instructions on reverse) office of workers' compensation programs omb no. 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 employer's first report of injury. 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? How do i report an injury? Web this form quickly to allow your insurer time to investigate the claim. Web employer's first report of injury. In all other cases, report the injury to your employer. Your insurer will report the injury to the department of labor and industry (department), when necessary. 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. Department of labor (see instructions on reverse) office of workers' compensation programs omb no. Home phone ( ) 5. Web reporting an injury there's an injury, now what? Name (last, first, m.i.) 2.
