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Office of Workers' Compensation Programs. Instructions: Complete this form as soon as possible after an incident that results in serious injury or illness.The records must be maintained at the worksite for at least five years. Please complete in triplicate (type if possible) Mail two copies to: OSHA CASE NO. FATALITY. INSTRUCTIONS FOR EMPLOYERS FIRST REPORT OF. INJURY OR ILLNESS (DWC FORM-001). Type (or print in black ink) each item on this form. This form is for the employer to report every work-related injury to its insurance company. This Form Is Semi-Interactive And May Be Filled Out Online. (Please read the instructions on page 2 for completing this form). WC-1 EMPLOYER'S FIRST REPORT OF INJURY OR OCCUPATIONAL DISEASE.