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If a physician treats an employee for a first aid injury, he or she is required to complete a "Doctor's First Report of Occupational Injury or Illness" (DFR, form 5021) and submit it to the employee's workers' compensation carrier (State Fund) within five calendar days of the initial examination. State Fund will then send a copy of the DFR to the Division of Labor Statistics and Research of the Department of Industrial Relations, as required. State Fund will also determine whether the injury or illness meets the Labor Code definition of first aid. If it is first aid, a copy of the DFR will be sent to the employer, with related bills, upon confirmation that the employer wishes to make payments for the first aid treatment. If no physician is involved in the first aid treatment, a DFR is not required.

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Q: What is a first report of injury form?
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Related questions

Who files the first report of injury and when is it filed?

Generally the supervisor files the first report of injury and does so after learning that an injury has occurred.


What is a Doctors First Report of Occupational Injury or Illness Form?

It is the doctors findings, Diagnosis, treament plans and report from the employees first visit with the treating physician.


What is an injury report?

An injury report is a document describing an injury and, sometimes conclusions about what caused the injury.


What is an report?

An injury report is a document describing an injury and, sometimes conclusions about what caused the injury.


When do you report injury?

Report an injury in the workplace as soon as possible after it happens.


What is the air force form for injury report?

The official form for injury reporting in the United States Air Force is called the AF Form 765, also known as the Uniformed Services Family Member's Serious Incident Report. It is used to document significant injuries or incidents involving family members of military personnel.


What is an injuries?

An injury report is a document describing an injury and, sometimes conclusions about what caused the injury.


What are some of the worker rights related to injury and illness report?

Knowing how to properly report an accident and injury and having access to the past injury and illness logs.


Full form of fir?

Full form of F.I.R is first important report.


What is full form of FIR?

FIR is First Information Report.


How do you write statements for your employer on workmans comp?

After an workplace injury, many employers request that an accident report be completed. You may be asked to complete an accident report if you are the injured employee, the injured employee's supervisor, or a witness to the injury. Your employer may have a specific form for you to fill out, and different information will be needed for each specific injury, but generally, a written accident report should include, at a minimum: -Date, time, and location of injury -What happened -Body parts that were injured -What could have been done to prevent the injury It is also a good idea to mention the name of the supervisor the injury was reported to and when, and when medical treatment was sought.


What is the full form of FIR according to police?

First Incident Report...