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Diately to the bureau on Form BWC-100 all injuries, including diseases, which arise out of and in the course of the employment, or on which a claim is made and result in any of the following: (a) Disability extending beyond seven (7) consecutive days, not including the date of injury. (b) Death. (c) Specific losses. In case of death, an employer shall also immediately file an additional report on BWC-106. See instructions on reverse side for filing/mailing procedures. I. EMPLOYEE DATA 1. Social.

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