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The Employer's First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimant's employment and circumstances surrounding the injury or illness are also requested.Office of Workers' Compensation Programs. Please complete in triplicate (type if possible) Mail two copies to: OSHA CASE NO. FATALITY. Employer's First Report of Injury or Disease. Document Number: WKC-12-E. Instructions: Complete this form as soon as possible after an incident that results in serious injury or illness. Complete Section A of this form immediately upon your knowledge of an injury and send the WC-1 to your insurance company or self-insurer claims office. WC-1 EMPLOYER'S FIRST REPORT OF INJURY OR OCCUPATIONAL DISEASE. The Department of Labor does not report any of the information or data filed on this form to the employer's workers' compensation carrier.