Workers Compensation First Report of Injury

  • First Report of Injury

    Please note that you should return this form or a copy of your own injury report form without the need for a completed claim form or medical certificates within 3 days of becoming aware of a work injury that may result in a claim or incapacity to the worker.

    However, we would request that you forward this additional information within 3 days of receiving the completed claim form from the worker.

  • Workers Details

  • Date Format: DD slash MM slash YYYY
  • Date Format: DD slash MM slash YYYY