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Are your Workers Compensation panels posted?
Are your Notification Forms signed? (For PA)
Gender
Marital Status
Employee Status
Is the Employee Owner/Officer, Partner?
Was employee paid for the day of injury?
Has Employee Returned to Work?
Paid While Injured?
Were Safeguards Provided?
Were Safeguards Used?
Was Accident on Premises?
Is this a Lost Time Claim?
Fatal?
Did Employee Commit an Unsafe Act?
Reason to doubt validity of claim
Is This Claim For Reporting Purposes Only?
Was Employee Treated In An Emergency Room?
Was Employee Hospitalized Overnight?
