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.
Please complete all required fields on the First Report of Injury form, as this will ensure timely entry of the claim.
Required information includes:
- Employer's name and policy number
- Injured worker's Social Security number
- First and last name
- Date of birth
- Part of body injured, specifying location, i.e. upper/lower back, right/left arm, etc.
- Injury type (strain, cut, fracture, etc.)
- Specific information on how the injury occurred
- Return to work information if the injured worker has missed any time from work
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:
- Download the FROI form from our Web site, complete it, and save it
- Click on Upload completed FROI to the State Insurance Fund Web site
- Click Browse to locate the completed FROI form on your computer
- Click "Secure Submit" to upload the completed form
- 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 .
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:
State Insurance Fund
P.O. Box 83720
Boise, ID 83720-0044
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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