Hawaii Injury Report Form

State:
Multi-State
Control #:
US-1340837BG
Format:
Word; 
Rich Text
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Description

This form is an example of an injury report form that may be used by a Company in order to report injuries on the job.

The Hawaii Injury Report Form is a crucial document used to report any incidents or accidents resulting in injuries that occur in the state of Hawaii. This form serves as a comprehensive record of the incident, allowing individuals or organizations to provide a detailed account of the injury, its causes, and the parties involved. By highlighting relevant keywords, one can elucidate the various aspects associated with the Hawaii Injury Report Form. Keywords: Hawaii, injury report form, incidents, accidents, injuries, document, report, record, detailed account, causes, parties involved. There are several types of Hawaii Injury Report Forms designed to cater to specific situations, namely: 1. Workplace Injury Report Form: This form is used to report any injuries sustained by employees while performing their job duties. It requires the injured employee or their supervisor to provide accurate and detailed information regarding the incident, including the date, time, location, nature of the injury, and any contributing factors. 2. Motor Vehicle Accident Injury Report Form: This specific form is utilized to report injuries resulting from motor vehicle accidents that transpire within the state of Hawaii. It includes sections to record relevant information such as the vehicle(s) involved, driver details, witness statements, and a comprehensive description of the injuries sustained. 3. Public Premises Injury Report Form: Designed for incidents occurring on public premises, this form is used to report injuries sustained by individuals visiting places such as parks, recreational areas, government buildings, or any publicly accessible locations. It captures vital information, such as the date, time, location, condition of the premises, and a detailed account of the injury sustained. 4. Sports-Related Injury Report Form: This form is tailored for reporting injuries that occur during sports activities, whether organized games or recreational events. It requires detailed information about the sport, participants involved, any equipment used, and a specific description of the injury sustained. Regardless of the type, the Hawaii Injury Report Form essentially serves to provide an accurate and detailed account of an injury and its circumstances. These forms play a crucial role in documenting incidents, which can help individuals or organizations analyze patterns, identify areas of improvement, fulfill legal requirements, and ensure appropriate actions are taken to prevent future injuries.

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FAQ

Hear this out loud PauseThe sum total of weekly benefits paid to all of the dependents can't be more than two-thirds of the deceased employee's average weekly wage. Hawaii workers' comp also pays for funeral expenses (up to ten times the maximum weekly TTD benefit) and burial expenses (up to five times the maximum weekly benefit). How Much Are Workers' Compensation Benefits in Hawaii? nolo.com ? legal-encyclopedia ? how-much... nolo.com ? legal-encyclopedia ? how-much...

How do you apply for workers' compensation? Write down the details of the injury or illness in detail, with photos and the names of witnesses when possible. Report the injury or illness to your employer. The employer should take it from there, filing your claim with the insurer. Workers' Compensation: What It Is, How It Works, and Who Pays investopedia.com ? terms ? workers-compen... investopedia.com ? terms ? workers-compen...

Hear this out loud PauseAny employer, other than those excluded (section 386-1), having one or more employees, full-time or part-time, permanent or temporary, is required to provide WC coverage for its employees. Disability Compensation Division | About Workers' Compensation (WC) hawaii.gov ? dcd ? home ? aboutwc hawaii.gov ? dcd ? home ? aboutwc

Compensation for permanent partial disability shall be paid in weekly installments at the rate of sixty-six and two-thirds per cent of the worker's average weekly wage, subject to the limitations on weekly benefit rates prescribed in section 386-31.

Workers' comp waiting periods by state StateWaiting period to receive workers' compGeorgia7 daysHawaii3 daysIdaho5 daysIllinois3 working days48 more rows ? When Does Workers' Comp Start Paying? The Waiting Period in ... atticus.com ? advice ? workers-compensation atticus.com ? advice ? workers-compensation

You may file Form WC-5, "Employee's Claim for Workers' Compensation Benefits" with this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you. You may be eligible for Temporary Disability Insurance (TDI) benefits while your WC claim is being investigated.

TTD benefits are calculated as two-thirds of your average weekly wage before your injury (usually determined based on your earnings during the previous 12 months). Like other states, however, Hawaii law sets a maximum weekly rate for TTD benefits, based on a percentage of statewide average wages.

You have two years to formally file a worker's compensation claim. The timeline begins from when the effects of the injury manifest, which is immediately for an acute injury. It may be delayed for a disease.

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EVERY QUESTION MUST BE ANSWERED FULLY TO AVOID FURTHER CORRESPONDENCE. The law requires the employer to furnish the injured/ill employee a copy of this report. Enter date employee returned to work using the format, mm/dd/yy, to indicate the numerical month, day and year. If there is no lost time, enter date of injury.Instructions how to fill out an Incident Report: · Your name (First and Last Name) · Position/Title · Telephone number · Email address: Please use your hawaii.edu ... FAX to: First Insurance Company of Hawaii (545-3120) and ORM–WC (956-2304). Original: WC Coordinator (do not file in employee's personnel folder) Feb 2, 2016 — View Form [PDF] 1. Please print and fill out this form to report a third-party liability injury or illness. Mail it to HMSA at the address below ... Items 1-32 serve as the injured employee's initial report of an accident and should be completed and submitted by the injured employee to his/her immediate ... Get Form. Video instructions and help with filling out and completing Hawaii Doe Accident Report Fillable Forms. Find a suitable template on the Internet. Complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a. This is the form the injured employee submits to the Department of Labor Disability Compensation Division, along with a physician's duly filled out WC-2 ... Forms for filing a claim for damage or injury with the Office of the County Clerk are listed below. Claim for damage or injury (printable only). Lobbyist ...

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Hawaii Injury Report Form