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Report An Accident Or Injury At Your Workplace

1) Accident Report Form
2) Letter from Employee Reporting An Accident
3) Accident Analysis Worksheet
4) Accident Report Log

About These Forms

When there is an accident or an incident involving an injury at work you may use these pre-written letters and forms to document the event.

A form is provided to report key details of an incident. A letter is provided so that the employee may provide a statement about the incident. Further forms allow you to complete an analysis and log incidents for a historical record.

Have you had an accident at work? You should report any accident to your employer immediately. Workers’ Compensation should cover you for any medical costs and also pay for time that you are unable to work. Any delay in reporting may affect your claim.

Almost all employers with more than one employee must buy Workers’ Compensation Insurance. To be covered by Workers’ Compensation you must be an employee and have a work related accident or become sick while conducting work related activities.

You can use these forms as a template to document your work related accident. The first thing you need to do is determine if your employer has submitted a First Report of Injury to your State’s Workers’ Compensation Carrier.

Ask your employer if they have submitted the above mentioned form. If they have not you must notify your State’s Workers’ Compensation Department and report to them that you were hurt at work and that your employer has failed to notify the Workers’ Compensation Insurance Company.

If the Doctor that you see has determined that you are temporarily disabled then the Workers’ Compensation Insurance Company should pay for any lost wages and benefits during your time that you miss work.

Some of the key Employee Accident Forms: Always report every injury or illness that is work related immediately. Then visit the correct medical provider. If your injury or illness is an emergency you will go where the first responder takes you. Otherwise, go where your employer directs you to or your bills may not be covered by Workers’ Compensation. Tell the Doctor that you were injured on the job when you are filling out the paper work at the hospital or doctor’s office. Your bills will then be sent to your employer or their Workers’ Compensation Insurance Company instead of you. Verify that your medical records include everything about your work related injury. If it is not documented you may not get paid.