First Report of Injury form

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A First Report of Injury (FROI) must be filed as soon as practicable but not later than 10 days after the occurrence of an injury or occupational disease.  A First Report of Injury should be filed if the injured worker:

• Requires medical treatment by a physician
• Is absent from work for one day or more
• Requests that a First Report of Injury be filed on his behalf

The filing of a First Report of Injury is not an admission of liability.  If an employer has concerns regarding the injury, a note should be attached to the First Report of Injury outlining any concerns.

Download the form

First Report of Injury or Illness [Word] - may be e-mailed or uploaded

First Report of Injury or Illness [PDF] (for printing and mailing)

Our instructions take you through each section and give helpful examples.

File by uploading: 

You can upload a completed First Report of Injury (FROI) directly to the State Insurance Fund. This is a secure sockets layer transmission with an encrypted connection. To upload the FROI:

1. Download the FROI form from our Web site, complete it, and save it
2. Click on Upload completed FROI to the State Insurance Fund Web site
3. Click Browse to locate the completed FROI form on your computer
4. Click "Secure Submit" to upload the completed form
5. Be sure to save the FROI for your records

File by e-mail:

The Word document can be e-mailed to the State Insurance Fund as an attachment.  Completed forms should be e-mailed as an attachment to the State Insurance Fund at .   The employer should keep a copy for their own files.  Questions about the form, instructions, or any difficulties downloading the form, should be sent to

File by mail:

The First Report of Injury form is included in the State Insurance Fund's Policyholder Information Packet.  The form is designed specifically for optical reading, and it is important that employers submit the original and not a photocopy or the yellow duplicate.   Put the original First Report of Injury in the yellow envelope provided in the Policyholder Information Packet and mail it to:

If additional copies of the form are needed, call 800-334-2370 or 208-332-2100.

File by phone:

In the event of an accident involving death, several workers, or very serious injuries that need to be reported immediately, we ask that the policyholder report the incident by phone as soon as possible (208-332-2100).  A State Insurance Fund representative will take preliminary information over the phone to ensure immediate action can be taken. The employer should then submit a completed First Report of Injury as soon as possible.

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