• Complete all forms legibly in blue ink, typed is preferable. (See All Sample Forms)

• Do not alter any of online forms, as altered forms will not be accepted.

• Forms must have original signatures and all documents must be original.

• Employer’s First Report and Employee’s Notice of Injury or Occupational Illness Form must be completed by both the injured worker and employer. NOTE: Previous versions of the Employer’s First Report are not acceptable (See Sample Forms)

1.  No Loss Injury:
   An employee who does not wish to pursue medical treatment or did not lose time from work, should submit a letter to close the case.
2.  Late Filing:
   When an injury occurs on the job, it is mandatory that the employer files an Employer’s First Report and Employee’s Notice of Injury or Occupational Illness Form along with the certificate. An Employer has eight days to submit an injury claim. Should a claim be filed past the eight (8) days, then a letter for late filing is needed. An Injured Worker has forty-eight (48) hours to notify the employer of an injury on the job. Should an Injured Worker notify their employer past forty-eight (48) hours, then a letter of explanation is needed from that Injured Worker.

• Certificate of Insurance from Government Insurance Fund is to be submitted by the employer with all Employer’s First Report and Employee’s Notice of Injury or Occupational Illness Form as proof that the business is insured for that calendar year. (See Sample Forms)

• A Surgeon’s Report must be fully completed by the physician’s office only. (See Sample Forms) Medical Reports or full Emergency Room Records are also accepted.

• An Employee’s Claim for Compensation for Disability form must be completed, notarized, and submitted if time is lost from work due to the work-related injury. (See Sample Forms)

• A completed W-9 form must be submitted by all injured Workers. (See Sample Forms)