When reporting an injury, it is important to fill out
the form as completely as possible. The following information is necessary to
get the claim registered.
Injured worker’s first and last name.
Injured worker’s Social Security number.
Date of the injury.
Policy number and/or policyholder’s business name.
Time loss information as indicated in No. 15 on the
FROI.
How the injury occurred and type of injury and body part
affected.