The Illinois First Report 45 form is a crucial document that employers must complete to report work-related injuries or illnesses. This form helps ensure that accurate records are maintained and that employees receive the necessary support following an incident. By filing this report, employers comply with state regulations while protecting the rights and well-being of their employees.
The Illinois First Report 45 form is a crucial document for employers in the state, designed to facilitate the reporting of workplace injuries and illnesses. This form captures essential details, including the employer's information, the nature of the business, and specifics about the employee involved in the incident. It asks for the employee's demographics, job title, and average weekly wage, along with critical data regarding the accident itself, such as the date and time it occurred, the circumstances surrounding it, and the nature of the injury. Employers must indicate whether the incident resulted in lost workdays and provide information about any medical treatment received. The form also requires the signature of the person preparing the report, ensuring accountability in the reporting process. By law, employers are obligated to submit this form to the Illinois Workers' Compensation Commission for any injury that results in the loss of more than three scheduled workdays, emphasizing the importance of accurate record-keeping. Confidentiality is maintained throughout the process, and submitting the report does not imply liability under the Workers’ Compensation Act. Understanding the requirements and implications of the Illinois First Report 45 form is vital for both employers and employees to navigate the complexities of workplace injuries effectively.
What is the Illinois First Report 45 form?
The Illinois First Report 45 form is a document that employers must complete to report work-related injuries or illnesses to the Illinois Workers' Compensation Commission. It captures essential information about the incident, including details about the employee, the nature of the injury, and the circumstances surrounding the accident.
Who needs to fill out the First Report 45 form?
Employers are responsible for completing the First Report 45 form whenever an employee suffers a work-related injury or illness that results in more than three scheduled workdays lost. This requirement applies to all employers in Illinois, regardless of the size of their business.
What information is required on the form?
The form requires detailed information, including the employer's FEIN, the employee's full name, birthdate, mailing address, job title, and average weekly wage. Additionally, it asks for specifics about the accident, such as the date and time it occurred, the nature of the injury, and the treatment received.
Is the information provided on the form confidential?
Yes, the information included in the First Report 45 form is confidential. It is protected under the Workers' Compensation Act, and employers must handle it with care to maintain privacy.
What should I do if the employee died as a result of the accident?
If the employee dies due to the work-related accident, the form requires you to provide the date of death. This information is crucial for the Workers' Compensation Commission to process any claims related to the incident.
How do I submit the First Report 45 form?
After completing the form, you must send it to the Illinois Workers' Compensation Commission at the following address: 4500 S. Sixth St. Frontage Rd, Springfield, IL 62703. Ensure that you submit it promptly to comply with reporting requirements.
What happens if I fail to report an injury?
Failing to report a work-related injury or illness can lead to penalties for the employer. Additionally, it may affect the employee's ability to receive workers' compensation benefits. Accurate record-keeping is essential to comply with state laws.
Can I report an injury that does not result in lost workdays?
While the First Report 45 form is primarily for cases resulting in lost workdays, employers are still encouraged to maintain records of all work-related injuries and illnesses, even minor ones. This helps ensure a safe work environment and compliance with regulations.
Is filing the form an admission of liability?
No, filing the First Report 45 form does not affect liability under the Workers' Compensation Act. It is merely a reporting requirement and is not considered incriminatory in any way.
Failing to type or print clearly. If the form is difficult to read, it may lead to processing delays.
Not providing the correct Employer's FEIN. This number is crucial for identifying the employer and the case.
Missing the employee's full name. Ensure that the name matches official documents to avoid confusion.
Incorrectly marking whether it is a lost workday case. This detail is essential for the workers' compensation process.
Leaving out the date and time of the accident. This information is vital for establishing the timeline of events.
Not specifying the nature of the injury or illness. Clearly describe what happened to the employee for accurate reporting.
Failing to list the part of the body affected. Include this detail to ensure proper medical and legal follow-up.
Omitting the name and address of the physician who treated the employee. This information is important for medical records.
Neglecting to sign the form. A signature is necessary to validate the report.
Not sending the form to the correct address. Ensure it is sent to the Illinois Workers' Compensation Commission to avoid delays.
ILLINOIS FORM 45: EMPLOYER'S FIRST REPORT OF INJURY
Please type or print.
Employer's FEIN
Date of report
Case or File #
Is this a lost workday case?
Yes
No
Employer's name
Doing business as
Employer's mailing address
Employer’s email address
Nature of business or service
SIC code
Name of workers' compensation carrier/admin.
Policy/Contract #
Self-insured?
Employee's full name
Birthdate
Employee's mailing address
Employee's e-mail address
Gender
Marital status
# Dependents
Employee's average weekly wage
Male
Female
Married
Single
Job title or occupation
Date hired
Time employee began work
Date and time of accident
Last day employee worked
If the employee died as a result of the accident, give the date of death.
Did the accident occur on the employer's premises?
Address of accident
What was the employee doing when the accident occurred?
How did the accident occur?
What was the injury or illness? List the part of body affected and explain how it was affected.
What object or substance, if any, directly harmed the employee?
Name and address of physician/health care professional
If treatment was given away from the worksite, list the name and address of the place it was given.
Was the employee treated in an emergency room?
Was the employee hospitalized overnight as an inpatient?
Report prepared by
Signature
Title and telephone #
Email address
Please send this form to: ILLINOIS WORKERS' COMPENSATION COMMISSION 4500 S. SIXTH ST. FRONTAGE RD SPRINGFIELD, IL
62703
By law, employers must keep accurate records of all work-related injuries and illness (except for certain minor injuries). Employers shall report to the Commission all injuries resulting in the loss of more than three scheduled workdays. Filing this form does not affect liability under the Workers’ Compensation Act and is not incriminatory in any way. This information is confidential. IC45 8/12
When filling out the Illinois First Report 45 form, it is important to follow specific guidelines to ensure accuracy and compliance. Here is a list of dos and don’ts:
The Illinois First Report 45 form is a critical document for employers to report work-related injuries. However, several other forms and documents often accompany it in the workers' compensation process. Understanding these documents can streamline the reporting and claims process, ensuring that all necessary information is communicated effectively.
Filing the Illinois First Report 45 form alongside these additional documents helps create a comprehensive record of the incident and the subsequent actions taken. This thorough approach not only aids in the claims process but also fosters a safer work environment by addressing the root causes of workplace injuries.
Understanding the Illinois First Report 45 form is crucial for employers and employees alike. However, several misconceptions often arise regarding this important document. Here are six common misunderstandings:
Many believe that submitting the Illinois First Report 45 form is not mandatory. In reality, employers are legally required to report all work-related injuries that result in the loss of more than three scheduled workdays.
Some think the form is only necessary for serious accidents. However, it must be filed for any injury that leads to lost workdays, regardless of the injury's severity.
There is a common belief that completing the form implies the employer accepts responsibility for the injury. This is not true. The form is a necessary report and does not affect liability under the Workers’ Compensation Act.
Some individuals worry that the details in the report will be accessible to the public. In fact, the information provided is confidential and protected by law.
While employers are responsible for filing, employees can also report their injuries. Collaboration ensures that all necessary information is accurately conveyed.
It is a misconception that there is no deadline for submitting the report. Employers must file the form promptly after an injury occurs to comply with legal requirements.
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