Free Instructions - Idaho

File Size: 15.2 kB
Pages: 1
File Format: PDF
State: Idaho
Category: Workers Compensation
Author: mgale
Word Count: 193 Words, 1,180 Characters
Page Size: Letter (8 1/2" x 11")

Download Instructions ( 15.2 kB)

Preview Instructions
Instructions for Filling Out the Workers' Compensation First Report of Injury or Illness (IC1A-1)

1) The form should be filled out by the employer or a representative; however, the injured employee may fill out the form if necessary. 2) Fill out non-shaded areas as completely as possible. 3) Distribute copies of the completed form as follows: The original to: Idaho Industrial Commission PO Box 83720 Boise, ID 83720-0041 (If the form is completed by the injured employee, an additional copy should be sent to the Idaho Industrial Commission. The Idaho Industrial Commission will then send a copy to the adjuster.) The Microsoft Word version can be sent to the Idaho Industrial Commission as an email attachment to [email protected] One copy to the employer's workers' compensation insurer or adjuster. One copy retained for the employer's files.

4) The Idaho Industrial Commission will be happy to answer your questions or provide you with helpful brochures on Facts for Injured Workers and Guides for Employers. To obtain this service, please contact the Idaho Industrial Commission at (208) 334-6000; or you may access many of these brochures on these web pages.