Claims Forms & Documents

Common forms for injured workers and claims processes

First Report of Injury Forms

Click here to complete & submit the form online.
Alabama: Employer's First Report of Injury
Arkansas: First Report of Injury or Illness
Connecticut: Employers First Report of Occupational Injury
District of Columbia: First Report of Injury or Occupational Disease
Florida: First Report of Injury or Illness
Georgia: First Report of Injury or Occupational Disease
Louisiana: First Report of Injury or Illness
Mississippi: First Report of Injury or Illness
Missouri: Report of Injury
New Jersey: First Report of Injury or Illness
North Carolina: Employer's Report of Employee's Injury
Oklahoma: First Notice of Claim For Compensation
Pennsylvania: First Report of Injury
Rhode Island: First Report of Alleged Occupational Injury
South Carolina: First Report of Injury or Illness
Tennessee: Employer's First Report of Injury or Illness
Texas: First Report of Injury or Illness
Virginia: First Report of Injury

Report an Injury Email

Email a completed report
‍Email it to compcare@normandyins.com.

Report an Injury Fax

Fax a completed report
‍Fax it to 833-770-1220.

Mileage Reimbursement Request

English | Spanish

State Websites for Claims Forms

District of Columbia