Fillable tennessee first report 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...