Claims
When an injury occurs, employers have seven (7) days to report the incident (24 hours when the injury results in death).
Download DWC-1 FIRST REPORT OF INJURY OR ILLNESS
Have the following information ready:
- Full name, address, telephone number of injured employee
- Occupation, date of birth, sex of injured employee
- The injured employee's Social Security number
- Date and time of accident
- Employee's description of accident
- Injury/illness that occurred, part of body injured
- Company name, phone, address
- Employer's location if address is different from above
- Place/address accident occurred
- Federal Employer ID# and Policy Number
- Employee date of hire
- Did the employee return to work?
- Do you (the employer) agree with the accident?
- Name of physician or hospital where employee was sent by you for treatment