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Wisconsin first report of injury form
Wisconsin first report of injury form



Wisconsin first report of injury form

Download Wisconsin first report of injury form




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Date added: 10.01.2015
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form first injury report of wisconsin

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This form is for the employer to report every work-related injury to its insurance company. Employee Name (First, Middle, Last). Social Security Number. UW- Submit to your supervisor to complete the WKC-12 form. This is a Wisconsin State form required to be filed under P.O. This is first priority. EMPLOYER See instructions for completing this form on reverse side. (Please read the instructions on page 2 for completing this form). 15.04 (1)(m), Wisconsin Statutes]. EMPLOYER'S FIRST REPORT OF INJURY OR DISEASE. The supervisor will receive a form (WKC-12 Employer's First Report of Injury or Disease) to complete. If medical treatment is Download Wisconsin Employer's First Report of Injury Or Disease (pdf, 78KB) Form > Worker's Compensation Form > Wisconsin Worker's Compensation FormBox 1029, Fond du Lac, WI 54936-1029 Form FL_000 We don't recommend completing the First Report of Injury for lost-time claims, claims with the ACORD TM WISCONSIN EMPLOYER'S FIRST REPORT OF INJURY OR DISEASE An F.C.A. Follow Medical Emergencies as See Instructions for Completing Injury Reports, forms and resources to the right. University Of Wisconsin System. 4. If an employee is out more than 3 days due to a work-related injury, ACORD WISCONSIN EMPLOYER'S FIRST REPORT OF INJURY OR DISEASE. If an employee is out more than 3 days due to a work-related injury, This form is for the employer to report every work-related injury to its insurance company. 446, 551, 656, 842 & 1056 General Form 5a 8/2010 ORI No.
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