Hurt At Work Form

This helps us to identify and correct hazards before they cause serious injuries.

Hurt at work form.

Your supervisor may ask you to complete a form with information about the injury. For occupational hearing loss claims please complete the employer report of occupational hearing loss form you have three days to file the employer report of injury or illness from the date of the accident injury. Obtain the form from your employing agency complete and turn it in to your supervisor as soon as possible but not later than 30 days following the injury. For more detailed information.

If your employer does not have a form for you please complete the notice of injury to employer form. Please note that your employer will also report your injury to the wcb. The date you are informed of your employee s intent to seek medical treatment is considered the date you had knowledge of the claim. Go to a healthcare provider.

You should request a copy from your employer in the event you do not receive one. Your employer or the nominated return to work coordinator at your workplace your employer s worksafe agent to find out who the agent is check the if you are injured poster in your workplace or call worksafe s advisory service. Your employer may authorize medical treatment for occupational disease only if owcp gives prior approval. If at a later time your employee wishes to see a doctor the employee only needs to notify you of the intent to seek treatment.

Your employer should then complete the employer section and forward the completed claim form to his workers compensation insurance company. Take form ca 16 when you go to the doctor along with form owcp 1500 which the doctor must use to submit bills to owcp. Download a copy of the incident report form s 767 here. If you are hurt on the job whether it is due to an acute traumatic injury like cutting yourself on a saw cumulative trauma injury like carpal tunnel syndrome or some other job related injury there are several basic things you should do.

Injured workers call me all the time asking me what they need to do to make sure they protect their legal rights. Date of the diagnoses of illness or date your employee reported the injury or illness to you. This notification requires you to complete and file the 801 form english english with form fields spanish spanish with form fields with saif. For occupational written notice disease use form ca 2 instead of form ca 1.

Employees shall use this form to report all work related injuries illnesses or near miss events which could have caused an injury or illness no matter how minor. The form workers must complete in order to lodge a claim. Employee s report of injury form. File in traumatic injuries complete the employee s portion of form ca 1.

If you need help completing this form you can contact. Tell your supervisor right away that you were hurt at work. Your employer should give you a copy of the completed claim form.