Select your state below and submit an online report of injury. Note: You will not be able to complete the submission process from saved or book marked forms. Please do not close this window until after the Report of Injury form has been submitted. |
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Report all job-related accidents and injuries by calling 1-800-440-5020. You'll reach a live person 24 hours a day, 7 days a week. We will help arrange immediate medical treatment and answer your questions about workers' comp benefits. |
| If you need help finding a medical provider in your area, click here. |
| If you are reporting a serious or fatal claim in California, click here for Cal/OSHA reporting requirements. |
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Call 911 to arrange transportation to the nearest medical facility.
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Call First CallŪ (1-800-440-5020) immediately.
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Your policyholder number;
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Description, date and time of accident;
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If the employee received medical attention prior to your call to First Call, have the name, address and phone number of the doctor or hospital that treated the injured employee; and
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The injured employee's name, address, Social Security number, date of hire, occupation, wages and date of birth.
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Use this checklist to teach your employees what to do if they're injured on the job: |
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Report the injury immediately to your supervisor. |
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Seek medical attention if necessary. |
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Let us know if any tools or equipment were involved in the accident, especially if they were faulty. |
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Let us know which co-workers witnessed the injury. |
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Let us know steps we can take to prevent such accidents from occurring again. |
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Keep us informed of your care and treatment plan. |
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Call your supervisor if you have questions or ideas about getting back to work. |
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