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Kansas First Report of Injury Form

Product Specifications:

  • This form is 8.5" x 11"
  • 25 Forms/Package


* Required Fields


The Kansas Department of Labor Division of Workers Compensation requires that employers file information immediately if there has been an injury or death in the workplace. Each time an employer fails to file an Accident Report, the employer may be subject to a $250 penalty, as long as the employer knew about the incident and failed to file the report within 28 days.

The Kansas First Report of Injury Form includes questions about how the accident occurred, details about the nature of the injuries, and a classification system for the injury, including no time lost, time lost, and even death. This form also includes information about how to fill the form out in detail, including specific instruction for each of the questions listed in the form.

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