Wisconsin Employer's First Report of Injury or Disease — This is a Word file that is protected from modification and enabled for form fill (includes tabbed fields for form completion). The Wisconsin Employer's First Report of Injury or Disease is a form used by employers to report workplace injuries or diseases to the Wisconsin Department of Workforce Development. The form is designed to be completed electronically and includes tabbed fields for the user to enter information into. The form includes sections for the employer to provide information about the incident, the employee, the type of injury/illness, treatment information, and details about the worker’s compensation insurance coverage. The form also includes a section for the employer to provide an explanation of the injury/illness and a summary of the employer’s investigation into the incident. There are two types of Wisconsin Employer's First Report of Injury or Disease: Form WC-1 and Form WC-2. Form WC-1 is used when reporting a workplace injury or illness, while Form WC-2 is used when reporting a death due to a workplace injury or illness.
Wisconsin Employer's First Report of Injury or Disease -- This is a Word file that is protected from modification and enabled for form fill (includes tabbed fields for form completion).
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A detailed narrative progress/supplemental report is filed to document any significant change in the worker's medical or disability status.
An injured employee should give notice to the employer within 30 days of any injury. In the case of an occupational disease, the employee should give notice within 30 days of the time the employee knows about the disability and its relation to the employment.
Injured postal workers are required to fill in form CA-17, which is a form which outlines information from a doctor forbidding an injured federal employee from carrying out certain activities due to their inherently physically taxing nature.
Worker's compensation form completed when the patient first seeks treatment for a work-related illness or injury. It does not contain a signature line. It is filed with State Worker's Compensatin Board/Commission.
The employer is required to file an Employer's First Report of Injury or Illness DWC FORM-001 Rev. 10/05 with the injured worker's insurance carrier, and the injured claimant or the claimant's representative within 8 days after the employee's absence from work or receipt of notice of occupational disease.
INSTRUCTIONS FOR COMPLETING FORM CA-2a NOTICE OF RECURRENCE. DEFINITION OF RECURRENCE. IF A NEW INJURY OR CONDITION DUE TO OCCUPATIONAL EXPOSURE OCCURS, AND DISABILITY OR THE NEED FOR MEDICAL CARE RESULTS, A NEW FORM CA-1 OR CA-2 SHOULD BE FILED.
Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider if the employee requires medical treatment because of a work-related traumatic injury. Your supervisor should complete page 1 of Form CA-16 and provide it to you for your attending physicians information.
To file a claim, an injured worker must: complete an Uninsured Employers Fund Claim Application (by calling (608) 266-3046 and requesting the UEF application form be mailed to them)