It will also be used to identify information and documents in those database systems regarding individuals who have claimed benefits under. Chapter 440, Florida ...

PART OF BODY AFFECTED: Indicate the part of body affected by the injury/illness, (eg. Right forearm, lower back). DEPARTMENT OR LOCATION WHERE ACCIDENT OR ...

DIVISION OF WORKERS' COMPENSATION. For assistance call 1-800-342-1741. or contact your local EAO Office. Report all deaths within 24 hours 1-800 ...

DWC1a Wage Statement. This form enables us to calculate the correct compensation that may be owed to your injured employee. Please complete the form and submit ...

Any person who, knowingly and with intent to injure, defraud, or deceive any employer or employee, insurance company, or self-insured program, ...

Request an "Employee's Claim for Workers' Compensation Benefits" form from your supervisor (it's also known as a DWC 1 form).

Form DFS-F2-DWC-1 (08/2004). Florida State University. Department of Environmental Health & Safety. 1200 Carothers Hall. Tallahassee. FL. 32306-4481. 59-6001874.

Copy the enclosed forms as needed. Employer's First Report of Injury or Occupational Disease (DWC-1). This form must be completed at the time of the injury and/ ...

1 янв. 2016 г. · To file a claim, complete the “Employee” section of the form, keep one copy and give the rest to your employer. Do this right away to avoid ...

Wage Statement Form. You must complete and provide a wage statement form (DFS-F2-DWC-1a) to your carrier for any employee who is entitled to wage replacement.