Filing this form does not affect liability under the w orkers'. Employers meeting criteria in step 3 must report. Employer's fein date of report case or file # is this a lost workday case? Springfield il 62704 ic45 12/04 filing. Web form revised 5/2018 il form 45 | page 1of illinois form 45:

Web osha form 300 log with information from the form 301 incident report or illinois form 45. Employers first report of injury or illness type only. Illinois workers' compensation commission 4500 s. Web please send this form to:

Filing this form does not affect liability under the workers' compensation act. Springfield il 62704 ic45 12/04 filing. Web employers shall report to the commission all injuries resulting in the loss of more than three scheduled workdays.

Employer's fein date of report case or file # is this a lost workday case? Illinois workers' compensation commission 4500 s. Employer’s first report of injury please type or print. Filing this form does not affect liability under the workers' compensation act. Web employers shall report to the commission all injuries resulting in the loss of more than three scheduled workdays.

Web please send this form to: Filing this form does not affect liability under the workers'. Web illinois form 45 is a report that your employer must fill out when you are injured on the job and miss more than three days of work.

Web Please Send This Form To:

Illinois workers' compensation commission 4500 s. Employers are required to report accidents to the commission on the form, “employer’s first report of injury” which is known as the form 45. Web employers shall report to the commission all injuries resulting in the loss of more than three scheduled workdays. Springfield il 62704 ic45 12/04 filing.

Web Form Revised 9/2023 Il Form 45 | Page 1 Of 1.

Web illinois form 45 is a report that your employer must fill out when you are injured on the job and miss more than three days of work. Filing of this report does not affect your liability under the workers’ compensation act and is not incriminatory in. Filing this form does not affect liability under the workers'. Employer's first report of injury please type or print.

Filing This Form Does Not Affect Liability Under The Workers'.

Web please send this form to: Illinois workers' compensation commission 4500 s. Illinois workers' compensation commission 4500 s. By law, employers must keep.

Employers Meeting Criteria In Step 3 Must Report.

Filing this form does not affect liability under the w orkers'. Web shall report to the commission all injuries resulting in the loss of more than three scheduled workdays. Employee’s first report of injury please type or print date of report date of injury case or file # is this a lost workday case? Illinois workers' compensation commission 4500 s.

Employers first report of injury or illness type only. Web employers shall report to the commission all injuries resulting in the loss of more than three scheduled workdays. Employer's fein date of report case or file # is this a lost workday case? Web form revised 5/2018 il form 45 | page 1of illinois form 45: Web please send this form to: