Keeping it all Straight

By law, employers are required to report workers comp incidents. What, when, where and how? That depends on the state. Here are just a few of the differences:

 

  • WHAT - States have unique First Reports - that means unique pieces of data.
  • WHEN - Ten days? Seven? How about 21? When are you required to report?
  • HOW - EDI? Email? Fax? Some states even require you to send them a paper report.

 

The differences are problematic for an employer who operates in more than one state. That’s where ClaimCompass comes in. We keep track of all the different forms, different rules, different everything-else so you don’t have to. 

 

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All you have to do is come to ClaimCompass and fill in the form. We take care of the rest.

Our Research... Your Gain

We spend a great deal of time researching First Report forms and regulations. That's one of the things that sets us apart - we know our stuff when it comes to First Reports.research

 

Click on any state to download a PDF version of the state’s First Report of Injury.

 

We hope this information will be helpful to you. You can search around and find it (like we do), or you can just come here and find it all in one place.


Alabama

Alabama Employers First Report of Injury Or Occupational Disease
Form Num:WCC Form 2
Rev Date:3-6-2011
Pref Method:EDI

Info and Downloads

Alaska

Alaska Report of Occupational Injury Or Illness
Form Num:Jul-01
Rev Date:4-11-11
Pref Method:EDI

Info and Downloads

Arizona

Employer's Report of Industrial Injury
Form Num:ICA 04-0101
Rev Date:
Pref Method:Fax or Mail

Info and Downloads

Arkansas

Workers Compensation First Report of Injury
Form Num:1A-1
Rev Date:
Pref Method:EDI or Email

Info and Downloads

California

California Employer's Report of Occupational Injury or Illness
Form Num:5020
Rev Date:6/2/2011
Pref Method:EDI

Info and Downloads

Colorado

Colorado Employer's First Report of injury
Form Num:WC1
Rev Date:
Pref Method:EDI or Online

Info and Downloads

Connecticut

Employer's First Report of Injury
Form Num:N/A
Rev Date:7-9-11
Pref Method:EDI or Online

Info and Downloads

Delaware

First Report of Occupational Injury Or Disease
Form Num:...10-04
Rev Date:N/A
Pref Method:Fax or Mail

Info and Downloads

District of Columbia

Form Num:
Rev Date:
Pref Method:

Info and Downloads

Florida

First Report of Injury Or Illness
Form Num:DFS-F2-DWC-1
Rev Date:3/9/11
Pref Method:EDI

Info and Downloads

Georgia

Employer's First Report of Injury Or Occupational Disease
Form Num:WC-1
Rev Date:7/6/11
Pref Method:EDI

Info and Downloads

Hawaii

Employer's Report of Industrial Injury
Form Num:WC-1
Rev Date:11/1/11
Pref Method:Mail

Info and Downloads

Idaho

First Report of Injury Or Illness
Form Num:1A-1
Rev Date:2/1/98
Pref Method:Fax or Email

Info and Downloads

Illinois

Employer's First Report of Injury
Form Num:Form 45
Rev Date:6/11/11
Pref Method:EDI

Info and Downloads

Incident Only

Incident Only
Form Num:
Rev Date:
Pref Method:

Indiana

First Report of Employee Injury, Illness
Form Num:34401
Rev Date:3/1/11
Pref Method:EDI

Info and Downloads

Iowa

First Report of Injury Or Illness
Form Num:1.2
Rev Date:12/1/98
Pref Method:EDI

Info and Downloads

Kansas

Employer's Report Of Accident
Form Num:K-WC 1101-A
Rev Date:2/6/11
Pref Method:EDI or Fax

Info and Downloads

Kentucky

First Report of Injury Or Illness
Form Num:1A-1
Rev Date:2/1/95
Pref Method:EDI

Info and Downloads

Louisiana

Employer Report of Injury/Illness
Form Num:LWC-WC-1007
Rev Date:7/8/11
Pref Method:Online

Info and Downloads

Maine

Employer's First Report of Occupational Injury Or Disease
Form Num:WCB-1
Rev Date:1/2/11
Pref Method:EDI

Info and Downloads

Maryland

First Report of injury Or Illness
Form Num:1A-1
Rev Date:N/A
Pref Method:Online or Mai

Info and Downloads

Massachusetts

Employer's First Report of Injury Or Fatality
Form Num:WC 101
Rev Date:7/10/11
Pref Method:Online

Info and Downloads

Michigan

Employer's Basic Report Of Injury
Form Num:WC 100
Rev Date:
Pref Method:Mail or Fax

Info and Downloads

Minnesota

First Report of Injury
Form Num:MN FR01
Rev Date:5/8/11
Pref Method:EDI

Info and Downloads

Mississippi

First Report of Injury Or Illness
Form Num:1A-1
Rev Date:Sep 2011
Pref Method:EDI or Fax

Info and Downloads

Missouri

Report Of Injury
Form Num:WC-1-EDI
Rev Date:6/6/11
Pref Method:EDI or Fax

Info and Downloads

Montana

First Report of Injury Or Occupational Disease
Form Num:ERD-991
Rev Date:10/8/11
Pref Method:Fax or EDI

Info and Downloads

Nebraska

First Report of Alleged Occupational Injury or Illness
Form Num:NWCC Form 1
Rev Date:11/6/11
Pref Method:EDI

Info and Downloads

Nevada

Employer's Report Of Industrial Injury or Occupational Disease
Form Num:Form C-3
Rev Date:11/5/11
Pref Method:

Info and Downloads

New Hampshire

Employer's First Report of Occupational Injury or Disease
Form Num:Form 8WC
Rev Date:7/1/95
Pref Method:EDI

Info and Downloads

New Jersey

First Report of Injury Or Illness
Form Num:1A-1
Rev Date:1/2/11
Pref Method:EDI

Info and Downloads

New Mexico

Employer's First Report of injury or Illness
Form Num:WCA Form E1.
Rev Date:7/2/11
Pref Method:EDI

Info and Downloads

New York

Employer's Report of Work-Related Injury/Illness
Form Num:C-2
Rev Date:1/11/11
Pref Method:11/1/11

Info and Downloads

North Carolina

Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission
Form Num:Form 19
Rev Date:8/8/11
Pref Method:Email or Fax

Info and Downloads

North Dakota

Employer's Report of Injury
Form Num:SFN 13660
Rev Date:4/3/11
Pref Method:Online or Fax

Info and Downloads

Ohio

First Report of an Injury, Occupational Disease or Death
Form Num:BWC-1101
Rev Date:8/5/11
Pref Method:Online or Fax

Info and Downloads

Oklahoma

Employer's First Notice of Injury
Form Num:Form 2
Rev Date:10/10/11
Pref Method:Mail Only

Info and Downloads

Oregon

Employer's Report of Occupational Injury or Disease/Illness
Form Num:801
Rev Date:5/2/11
Pref Method:Fax or Mail

Info and Downloads

OSHA 301

OSHA 301
Form Num:
Rev Date:
Pref Method:

Pennsylvania

Employer's Report of Occupational Injury or Disease
Form Num:LIBC-344
Rev Date:1/11/11
Pref Method:EDI or Online

Info and Downloads

Rhode Island

Employer's First Report of Alleged Occupational Injury or Disease
Form Num:DWC-01
Rev Date:1/3/11
Pref Method:EDI

Info and Downloads

South Carolina

First Report of Injury or Illness
Form Num:WCC Form 12-
Rev Date:4/6/11
Pref Method:EDI

Info and Downloads

South Dakota

Employer's First Report of Injury
Form Num:DOL-LM-101
Rev Date:2/8/11
Pref Method:Online

Info and Downloads

Tennessee

Employer's First Report of Work Injury or Illness
Form Num:C-20
Rev Date:12/7/11
Pref Method:EDI

Info and Downloads

Texas

Employer's First Report of Injury or Illness
Form Num:DWC FORM-1
Rev Date:10/11/11
Pref Method:EDI

Info and Downloads

Utah

Employer's First Report of Work Injury or Illness
Form Num:Form 122
Rev Date:2/9/11
Pref Method:Email or Fax

Info and Downloads

Vermont

Employee's Claim & Employer First Report of Injury
Form Num:Form 1
Rev Date:1/2/11
Pref Method:EDI

Info and Downloads

Virginia

Employer's Accident Report
Form Num:VWC Form No.
Rev Date:3/2/11
Pref Method:

Info and Downloads

Washington

First Report of Injury or Illness
Form Num:1A-1
Rev Date:1/2/11
Pref Method:Fax or Online

Info and Downloads

West Virginia

Employer's Report of Injury
Form Num:WC-3
Rev Date:10/3/11
Pref Method:

Info and Downloads

Wisconsin

Employer's First Report of Injury Or Disease
Form Num:WKC-12
Rev Date:3/2/11
Pref Method:EDI

Info and Downloads

Wyoming

Workers' Safety & Compensation
Form Num:INJRPT
Rev Date:10/3/11
Pref Method: Mail Only

Info and Downloads