This section is for when a work injury has occurred. Please read through the information to fully understand the process to follow in the event of an injury.
Under the title labeled "Information about your company", you will find the field where you can enter the name of your company.
Under the title labeled “Employee Identifying Information”, enter the injured employee’s name, the employee ID #, the type of ID, select the type of ID (drop down menu), the employee’s physical address, city, state, zip, phone number(s), email address(es), and mailing address if different from the physical address.
The next section is the “Witness Information & Statement”. The purpose of this section is to collect information from the witness of the accident. Please input the name of the witness, their title, email, work phone number, personal phone number and add any notes or statements.