Web3. Address (Street, City or Town, State, Zip Code) 4. Telephone Number DISABILITY INFORMATION 5. My disability was caused by: sickness, accident. Describe (if accident, give date, place and circumstances): 6. The first day I was unable to perform the duties of my job: (month) (day) (year) 7. Was this disability caused by your job? WebGet the Wc 1 Form Hawaii you need. Open it with online editor and start adjusting. Fill in the blank fields; concerned parties names, places of residence and numbers etc. Change the …
Fatal Work Injuries in Hawaii – 2024 : Western Information Office : …
WebIt is also responsible for the implementation and maintenance of the State’s Return to Work Priority Program which seeks to find alternate employment for those who can no longer perform the work that they were hired to do. … Webimportant the wc-1 employer's report of industrial injury is an employer's report to the hawaii state department of labor and industrial relation's disability compensation division.this … buttercup essence flower
FORM HW-4 (REV. 2024) STATE OF HAWAII - University of …
WebHawaii's federal workers must file their WC claim through the Office of Workers' Compensation Programs (OWCP), U. S. Department of Labor, District No.13, 71 Stevenson Street, Box 3769, San Francisco, CA 94119-3769. The phone number is (415) 744-6610. HOW DO I FILE A WC CLAIM? WebState actions to prevent similar accidents throughout entire department. _____ _____ Departmental Personnel Officer, Safety Officer, Date or Safety Council Representative Signature 36. Disposition of report ¤ WC-1 ¤ OSHA 200 ¤ For Record only Cause of Accident Example: An employee falls from a ladder. buttercup edit