5 Forms for Workers Comp
In order for your claim to be accepted by the State of New Mexico, we must have all 5 forms in. Below are the 5 forms that you'll need along with more information about how to fill them out:
- First Report of Accident - Instructions and E1-1 Form
- First Report of Accident - Instructions and E1-1 Form (Branch Campuses or Out of Albuquerque)
The First Report of Accident form is the basic notice of the incident, where the injured party lets us and the supervisor know that an incident occurred. This should be filled out regardless of if the supervisor was a witness to the injury/accident; it is just letting everyone know that something did happen.
The first page is the instruction page, explaining what needs to be filled out on the form and what information is required.
The second page goes into the department, employee name, hire date, when the injury/accident occurred, and what happened. It's important to fill this out as best you can, even if the time ends up being estimated. This gives us a general idea of what to tell the state and let them know what steps have been taken. It also lets us know if there are any safety concerns so we can address them at this time.
The third page is for the details of what happened; each column goes over the Source of the Accident, the Cause of the Accident, the Body Part Injured, and the Injury Result. At the bottom of each column is a place to write in the code number as well so you can make sure that the code is properly entered. The bottom of the page is then filled out by your supervisor, where they can write in when they were notified, fill out their information, and then have you sign and date it.
Please note that this form should be filled out by both the Supervisor and the Employee as close to the injury as possible; it's best if you both fill it out together to go over what happened, but if you do have to leave it on your supervisor's desk, please make sure to follow up with them to make sure it is submitted on time!
