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New York Report of Work-Related Injury Or Occupational Disease

State:
New York
Control #:
NY-ADR-1-WC
Format:
PDF
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Description

Report of Work-Related Injury Or Occupational Disease
New York Report of Work-Related Injury Or Occupational Disease is a form used to report any work-related injuries or illnesses that occur in the state of New York. It is a mandatory requirement for employers, insurance carriers, and self-insured employers to report any injuries or illnesses to the New York State Workers’ Compensation BoardWEBCB). The form must be completed within 10 days of the incident and sent to the WEB. There are two types of New York Report of Work-Related Injury Or Occupational Disease forms: C-2 and C-3. The C-2 form is used to report any injury or illness that requires medical treatment or hospitalization. The C-3 form is used to report any occupational disease or illness that develops over time, such as hearing loss, chronic lung disease, or a cumulative trauma disorder. The form must include information about the employee, the nature of the injury or illness, and the treatment received.

New York Report of Work-Related Injury Or Occupational Disease is a form used to report any work-related injuries or illnesses that occur in the state of New York. It is a mandatory requirement for employers, insurance carriers, and self-insured employers to report any injuries or illnesses to the New York State Workers’ Compensation BoardWEBCB). The form must be completed within 10 days of the incident and sent to the WEB. There are two types of New York Report of Work-Related Injury Or Occupational Disease forms: C-2 and C-3. The C-2 form is used to report any injury or illness that requires medical treatment or hospitalization. The C-3 form is used to report any occupational disease or illness that develops over time, such as hearing loss, chronic lung disease, or a cumulative trauma disorder. The form must include information about the employee, the nature of the injury or illness, and the treatment received.

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FAQ

Each recordable injury or illness case must be recorded on the OSHA 300 Log and the Form 301 Incident Report within seven calendar days after the employer receives notice that the injury or illness occurred.

Report the injury or illness to your employer If you don't report your injury within 30 days, you could lose your right to receive workers' compensation benefits.

The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid.

All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.

Insurers or claims administrators must report a work-place injury or illness to the New York State Workers' Compensation Board on or before the 18th day after the workplace injury or illness occurred, or within 10 days after the employer learns of the event ? whichever period is greater.

Employers must report work-related fatalities within 8 hours of finding out about them. Employers only have to report fatalities that occurred within 30 days of a work-related incident. For any inpatient hospitalization, amputation, or eye loss employers must report the incident within 24 hours of learning about it.

Workers must report all workplace incidents, hazardous conditions, near misses, and property and environmental damage to their immediate supervisor as soon as possible.

Call the 24/7 Accident Reporting Hotline phone at 1-844-879-2692.

More info

An Employee's Guide on Reporting A WorkRelated Injury Or Disease ; What Type Of Condition Do I Have? ; Traumatic Injury ; Occupational Disease.If you're not sure whether a. Follow These Steps to Report a Work-Related Injury. Private industry employers reported 2. 6 million nonfatal workplace injuries and illnesses in 2021, a decrease of 1. The Injuries, Illnesses, and Fatalities (IIF) program produces a wide range of information about workplace injuries and illnesses. This report should be completed online. The form will be sent automatically to the Workers Compensation office and entity Employee Health and the safety office. Complete this form as a claim for compensation.

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New York Report of Work-Related Injury Or Occupational Disease