Fillable tennessee first report form

Description of first report work form
TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT EMPLOYER S FIRST REPORT OF WORK INJURY OR ILLNESS JURISDICTION CLAIM STATE FILE CLAIM TYPE CODE MED ONLY INDEMNITY BECAME LOST TIME BECAME MED ONLY NOTIFY ONLY TRANSFER CLAIMS ADM/CARRIER CLAIMS ADM CLAIM INSURER CLAIM OSHA LOG CASE NAME OF INSURANCE CARRIER AND CITY E MPLOYER POLICY EMPLOYER FEIN STATE INSURED NAME PARENT CO. IF DIFFERENT THAN SIC CODE ZIP...
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tennessee first report
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