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Instructions: Complete this form as soon as possible after an incident that results in serious injury or illness. Tell what happened and how it happened.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. Please complete in triplicate (type if possible) Mail two copies to: OSHA CASE NO. FATALITY. 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. If you, the employer, need assistance to complete the form contact your workers' compensation insurance carrier or claims administrator. Employer's First Report of Occupational Injury or Illness.