Workers' Compensation First Report of Injury or Illness
Reminder: The First Report of Injury (IA-1) must be submitted by the supervisor (or designee) immediately after notification of injury. The first report of injury must be completed "within three (3) working days" per KRS 342.038, after the injury. Failure to comply with this statute can result in a fine being levied of up to $1,000.00 for each occurrence.
Please Complete the Following Steps:
- Open and complete the injury form. Once you have completed the form, click the "Print" button at the bottom of the page to save a copy for your records. (This feature will allow users to save an electronic copy of the injury report. Select the "CutePDF Writer" print feature to create electronic files. If you forget to save the file before submitting, the system will ask you again after submitting if you would like to print a copy.)
- Once you have saved the form to your computer, click the "Submit" button at the bottom of the page and your form will be delivered to the Personnel Cabinet for processing via a secure connection. You will receive a system generated confirmation email after submitting an injury report stating that your file has been successfully submitted with a date and time.
If you have any view or compatibility issues or questions, please contact the Workers Compensation Program at 502.564.6846 or by email at: Personnel.firstname.lastname@example.org.
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First Report of Injury form,
Submitting supporting or additional injury documentation:
Please refer to your e-mail confirmation for the link to securely submit supporting documentation for any claim reported to the Workers Compensation Office.