Workers' Comp First Report of Injury: How to Complete and File It

10/10/2026

The first report of injury (often shortened to FROI) is the document that turns a workplace accident into a workers' comp claim. Everything downstream depends on it: the adjuster's compensability decision, the first benefit check, medical authorization, and in many states the state agency's record of the claim. A late or sloppy report doesn't just irritate the carrier. It can delay the employee's benefits, draw state penalties, and create inconsistencies that surface later in a dispute.

This guide walks through the report the way an HR or safety coordinator actually completes it: who files, what to collect first, what goes in each section, the deadlines that apply, and how the report connects to your OSHA records. For the bigger picture of what to do in the hours after an accident, start with our workplace injury employer checklist.

What the First Report of Injury Is and Who Files It

The first report of injury is the employer's report of a work-related injury or illness to its workers' comp insurer or claims administrator, and in some states directly to the state workers' comp agency. It is different from:

• The employee's notice to the employer that they were hurt (often verbal, sometimes a written statement)
• The employee's claim form, which some states require the employee to file to formally open a claim (California's DWC-1 is an example)
• OSHA's Form 301, the injury and illness incident report kept for OSHA recordkeeping

Many carriers accept the industry-standard ACORD 4, Workers Compensation First Report of Injury or Illness, which follows the IAIABC data standard. Several states require their own form instead. Examples:

State	Employer report form	Goes to
California	Form 5020, Employer's Report of Occupational Injury or Illness	Claims administrator
Texas	DWC Form-001, Employer's First Report of Injury or Illness	Insurance carrier, with a copy to the employee

 

In monopolistic states (North Dakota, Ohio, Washington and Wyoming), the report goes to the state fund through its own forms and online system. Self-insured employers and those using a third-party administrator file through the TPA. Behind the scenes, many states now require claims administrators to transmit first-report data electronically to the state agency, which is one reason accuracy on your end matters.

Who in the company files it? Pick one owner (HR, safety or a workers' comp coordinator) and one backup. Supervisors gather information; the owner submits the report. Splitting submission across supervisors is how reports get missed.

Information to Gather Before Filling It Out

Completing the form takes ten minutes if you have the facts and two days if you don't. Collect these first:

About the employee

• Full legal name, address, phone, date of birth, date of hire
• Job title and occupation, department, and whether full-time, part-time or seasonal
• Wage information: rate of pay, hours per day and days per week, and any other compensation such as overtime, tips or meals and lodging the claims administrator will need for the benefit rate
• Identification numbers as required by your carrier or state (follow the form's instructions; some states restrict use of Social Security numbers)

About the incident

• Date, time and exact location (address, or on-site location such as "loading dock 3")
• Date the employer was first notified, and by whom
• Time the employee began work that day
• What the employee was doing, what happened, and the object or substance involved
• Witnesses' names and contact information

About the injury

• Body part and side (left/right)
• Nature of injury (strain, laceration, fracture, burn, exposure)
• Initial treatment: first aid on site, clinic, emergency room, hospitalization
• Name and address of the treating provider or facility
• Whether the employee lost time from work beyond the day of injury, the date the employee was last paid in full, and the return-to-work date if known

About the employer and policy

• Legal employer name, FEIN and location address
• Insurer name and policy number
• Industry or classification code if requested

Get the employee's own description in their words and the supervisor's account separately, before memories settle into one version.

Field-by-Field Walkthrough of a Typical Form

Forms differ in layout, but they collect the same core data. Here is how to approach each block.

Employer and insurer section

Use the legal entity name exactly as it appears on the policy. Mismatched entity names (for example, a d/b/a or a subsidiary) can stall a claim while the carrier confirms coverage. Enter the policy number and the location where the employee actually works.

Employee section

Enter the information from your HR system, not from memory. Confirm the address, because benefit checks and notices go there. List the occupation the employee was performing at the time of injury, even if it differs from their usual job title.

Wage section

This drives the benefit rate. Report the actual wage structure: hourly rate, scheduled hours, and any regular overtime or extra compensation. If wages vary, note it and be prepared to supply a payroll history. An understated wage leads to underpaid benefits and later corrections.

Occurrence section

Describe what happened in plain, factual language: "Employee was lifting a 40 lb box from a pallet to a shelf at shoulder height and felt pain in the lower back." Avoid conclusions ("employee was careless"), speculation ("probably an old injury") or legal labels ("not work-related"). If you doubt the claim, say so separately to the adjuster with your reasons; the report itself should stick to facts.

Injury and treatment section

Describe the body part and nature of injury as reported, and list where the employee was treated. If the employee declined treatment, note that.

Lost time and return to work section

Record the last day worked, whether the employee was paid for the full day of injury, and any known return date. Update the carrier when this changes; the first report is not the last word.

Preparer section

Name, title, phone and date. The adjuster will call this person, so list someone who will answer.

Deadlines: Employee Notice and Employer Report

Two separate clocks run. The employee notice clock is the time the employee has to tell the employer about the injury. The employer report clock is the time the employer has to report it to the carrier or state. Both are set by state law, and they vary widely. Examples:

State	Employee notice to employer	Employer report
California	Within 30 days of the injury	Give the employee a DWC-1 claim form within one working day of learning of the injury; send Form 5020 to the claims administrator within five days of knowledge
Florida	Within 30 days after the date or initial manifestation of the injury (Fla. Stat. 440.185(1))	Report to the carrier within 7 days after actual knowledge of the injury or death (Fla. Stat. 440.185(2)); fines can apply for failure to report
Texas	Within 30 days of the injury (Tex. Lab. Code 409.001)	DWC Form-001 to the carrier within 8 days after the employee's absence from work for more than one day due to the injury, or after notice of an occupational disease; copy to the employee

 

Two cautions. First, the employee's deadline is not a reason to delay your report: once you know about a work injury, start the employer's clock. Second, many carriers ask for a report of every injury, including first-aid-only cases, as soon as possible, even where state law only requires reports of lost-time injuries. Follow the stricter of your state law and your policy terms. Check your state workers' comp agency for its current rules, and see our guide to posting and reporting requirements for the related notices employers must display.

Common Errors That Delay Claims

• Waiting for the doctor's diagnosis. File with the information you have and update later.
• Filing to the wrong insurer. Common in multi-entity companies and for employees in monopolistic states.
• Wrong legal entity or policy number. The carrier cannot confirm coverage.
• Incomplete wage information. The adjuster cannot set the benefit rate.
• Opinion in the description. "Employee claims" or "alleged" language reads as hostile and adds nothing.
• No date of employer knowledge. That date starts several legal deadlines; record it precisely.
• Inconsistent accounts. The supervisor's version, the FROI and the OSHA 301 describe different events. Reconcile before filing.
• Not giving the employee required paperwork. Some states require you to give the employee a claim form, a copy of the report or a rights notice. Texas, for example, requires a copy of DWC Form-001 to go to the employee.
• Discouraging the report. Suggesting an employee use health insurance instead, or hinting that a report will cost them, invites retaliation claims and OSHA scrutiny.

Our article on filing a workers' comp claim covers what happens after the report reaches the carrier.

Linking the Report to Your OSHA Records

If your establishment keeps OSHA injury and illness records, the same incident may also need to go on the OSHA 300 Log and a Form 301. Three practical links:

1. Use one intake. Collect the facts once and feed both the first report and the OSHA forms. Your OSHA 301 must be completed within seven calendar days of learning of a recordable case (29 CFR 1904.29(b)(3)).
2. Equivalent forms. OSHA allows an equivalent form in place of the 301 if it contains the same information. Some employers use the workers' comp first report as the equivalent, adding any OSHA fields it lacks.
3. Different tests. A case can be reportable to the carrier but not OSHA-recordable, or the reverse. The workers' comp report does not decide recordability, and recordability does not decide compensability. Make each decision on its own criteria.

Also remember the separate duty to report severe injuries directly to OSHA: a work-related fatality within eight hours, and an in-patient hospitalization, amputation or loss of an eye within 24 hours (29 CFR 1904.39). Filing a first report with your carrier does not satisfy that obligation.

Learn the Full Injury Reporting Process

The first report of injury is one step in a claim that runs from the accident through benefits, return to work and premium impact. Our workers' comp training for HR covers the basics, and the Workers' Compensation Training & Certification program teaches injury identification and reporting, communicating with employees and insurers, the claims process, medical restrictions and records in a self-paced online course, with an optional exam for the Certified Workers' Compensation Administrator credential.

Frequently Asked Questions

What is a first report of injury in workers' comp?

It is the employer's report of a work-related injury or illness to its workers' comp insurer, claims administrator or, in some states, the state agency. It records who was hurt, when and how it happened, the injury, treatment, wages and lost time. The insurer uses it to open the claim, decide compensability and calculate benefits. It is separate from the employee's own notice of injury and from OSHA recordkeeping forms.

Is the ACORD 4 the same as the state first report of injury form?

Not always. ACORD 4 is the insurance industry's standard Workers Compensation First Report of Injury or Illness form, and many carriers accept it. Some states require their own form instead, such as California's Form 5020 or Texas's DWC Form-001. Monopolistic state funds use their own forms. Check with your carrier and your state agency which form to use for each state where you have employees.

Who fills out the first report of injury, the employer or the employee?

The employer. The employee provides information about what happened, and in some states files a separate claim form, but the first report of injury is the employer's responsibility. Assign one person in HR, safety or risk management to submit every report, with a backup, and have supervisors gather facts and witness information for that person.

How soon must an employer file a first report of injury?

It depends on the state. Florida requires a report to the carrier within 7 days after the employer knows of the injury. California requires Form 5020 to go to the claims administrator within five days. Texas requires DWC Form-001 within 8 days after an absence of more than one day. Many carriers want every injury reported immediately. Follow whichever deadline is shortest.

Do I need to file a first report if the employee only needed first aid?

State law often requires a report only when the injury involves lost time or medical treatment, but many carriers ask employers to report every injury, including first-aid cases. Reporting promptly costs little and protects the employee and employer if a minor injury later worsens. Check your policy and state rules, and record the incident internally either way.

Can the first report of injury be used as the OSHA 301?

It can, if it contains all the information the OSHA 301 requires. OSHA accepts equivalent forms such as workers' comp or insurance reports. Many employers add a short supplement covering any OSHA fields their workers' comp form lacks. The OSHA 301 or its equivalent must be completed within seven calendar days of learning of a recordable case.

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