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