Fill a Valid New Mexico Report Form Fill Out Form Here

Fill a Valid New Mexico Report Form

The New Mexico Report Form, officially known as the Employer's First Report of Injury or Illness, is a crucial document for reporting work-related injuries or illnesses. This form must be completed by employers when an employee suffers an injury or illness that results in more than seven days of lost work. Timely and accurate submission of this form is essential to ensure compliance with state regulations and to facilitate the claims process for affected workers.

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Key takeaways

When filling out and using the New Mexico Report form, it is essential to keep several key points in mind to ensure a smooth process. Here are five important takeaways:

  • Timeliness is Crucial: The form must be submitted within 10 days of learning about any work-related injury or illness that results in more than 7 days of lost work. This ensures compliance with state regulations and helps facilitate the claims process.
  • Accurate Information is Essential: All entries on the form should be clear and legible. Use black ink or type the information to prevent misunderstandings. Incomplete or illegible forms may be returned, causing delays.
  • Provide Comprehensive Details: Describe the injury or illness in detail, including the specific part of the body affected and the circumstances surrounding the incident. This information is vital for processing the claim effectively.
  • Know Your Responsibilities: Employers must complete this form even if they dispute the worker's claim. It is not an admission of liability but a necessary step to document the incident.
  • Keep Copies for Records: After submitting the original form to the New Mexico Workers' Compensation Administration, make sure to provide copies to the injured worker and the employer's insurance provider. This practice helps maintain transparency and accountability.

By understanding these key aspects, individuals can navigate the process more effectively, ensuring that all necessary information is accurately reported and submitted in a timely manner.

Other PDF Forms

New Mexico Filing Requirements for Non Residents - PTEs have specific requirements to meet when preparing this form annually.

The FedEx Release Form is an essential tool for those who want to ensure their packages are delivered even when they are not home. By completing this authorization document, customers can specifically instruct FedEx to leave their packages at a designated spot, making it convenient for them to receive their deliveries. It is crucial to provide the necessary details, such as a tracking number and recipient information, and to secure the form to the delivery location prior to the arrival of the courier. For more information on how to fill out this document, you can refer to the Fedex Release form.

New Mexico Wic Prescription - The form reflects comprehensive guidelines set forth by federal regulations.

Common mistakes

Filling out the New Mexico Report form can be straightforward, but many make common mistakes that can delay processing. One frequent error is failing to provide complete information about the employer. This includes the employer's name, address, and Federal Employer Identification Number (FEIN). Omitting these details can lead to confusion and delays in claim processing.

Another common mistake involves the date of injury or illness. Many people incorrectly enter the date the injury was reported instead of the actual date it occurred. It is crucial to accurately record the date of injury to ensure that the claim is processed in a timely manner. This date is essential for determining the eligibility of benefits.

In addition, individuals often neglect to specify the type of injury or illness. Instead of providing a clear description, they may use vague terms. Being specific about the nature of the injury helps in understanding the claim and assessing the necessary medical treatment. For example, stating “laceration to the right forearm” is more informative than just saying “injury.”

Another mistake is related to the section on the employer's location. If the injury occurred at a different site than the employer's main address, failing to provide that specific location can lead to complications. It is important to include the exact address where the employee was working when the injury happened.

Many also overlook the need to include the contact information for witnesses. This section is optional, but having witness details can support the claim. If applicable, including names and phone numbers of witnesses can provide additional evidence regarding the incident.

Additionally, individuals sometimes forget to check the box indicating whether safety equipment was provided and used. This information is vital for understanding the context of the injury. If safety measures were in place, it may influence the outcome of the claim.

Finally, a common oversight is submitting an illegible form. Handwriting that is difficult to read can result in delays or the need for resubmission. Always use black ink or type the information to ensure clarity. Taking the time to double-check the form before submission can prevent these issues and facilitate a smoother claims process.

Preview - New Mexico Report Form

NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION

EMPLOYERS' FIRST REPORT OF INJURY OR ILLNESS

2410 CENTRE AVE. SE ♦ PO BOX 27198 ALBUQUERQUE, NM 87125-7198

OFFICIAL USE ONLY

PLEASE PRINT IN BLACK INK OR TYPE.

EMPLOYER ( NAME & ADDRESS INCL ZIP )

CARRIER / ADMINISTRATOR CLAIM # OSHA LOG NUMBER

REPORT PURPOSE CODE

G

 

 

 

 

 

 

 

 

E

 

 

 

 

JURISDICTION

 

JURISDICTION CLAIM NUMBER

 

 

 

 

 

 

 

 

N

 

 

 

 

 

 

 

 

 

 

 

 

INSURED REPORT NUMBER

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

EMPLOYER'S LOCATION ADDRESS ( IF DIFFERENT )

LOCATION #

A

 

 

 

 

 

 

 

 

 

PHONE NUMBER

EMPLOYER FEIN

 

 

 

 

INDUSTRY CODE

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

CARRIER ( NAME, ADDRESS & PHONE NO )

 

POLICY PERIOD

CLAIMS ADMINISTRATOR ( NAME, ADDRESS & PHONE NO )

A

C

 

 

TO

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

RA I

R

M

 

 

 

 

 

 

 

CHECK IF APPROPRIATE

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

 

SELF INSURANCE

 

 

 

 

 

 

 

 

 

 

 

I

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

CARRIER FEIN

 

 

 

POLICY / SELF-INSURED NUMBER

 

 

 

 

ADMINISTRATOR FEIN

 

 

 

 

E

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

N

AGENT NAME & CODE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME ( LAST, FIRST, MIDDLE )

 

 

 

 

 

DATE OF BIRTH

SOCIAL SECURITY NUMBER

DATE HIRED

 

 

 

STATE OF HIRE

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS ( INCL ZIP )

 

 

 

 

 

 

GENDER

 

MARITAL STATUS

OCCUPATION/JOB TITLE OR (SOC)

P

 

 

 

 

 

 

 

 

 

MALE

 

 

UNMARRIED

CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SINGLE/DIVORCED

 

 

 

 

 

 

 

 

O

 

 

 

 

 

 

 

 

 

FEMALE

 

 

MARRIED

EMPLOYMENT STATUS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

 

 

 

 

 

 

 

 

UNKNOWN

 

 

SEPARATED

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

PHONE NUMBER

 

 

 

 

 

 

# OF DEPENDENTS

 

UNKNOWN

NCCI CLASS CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

W

 

RATE

 

PER:

 

DAY

 

MONTH

# DAYS WORKED/WEEK

 

FULL PAY FOR DAY OF INJURY?

 

YES

 

NO

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G

 

 

 

 

 

WEEK

 

OTHER:

 

 

 

 

 

 

DID SALARY CONTINUE?

 

 

 

YES

 

NO

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TIME EMPLOYEE

AM

DATE OF INJURY/ILLNESS

TIME OF

 

 

AM

LAST WORK

 

DATE EMPLOYER

DATE DISABILITY BEGAN

 

 

BEGAN WORK

 

 

 

 

OCCURRENC

 

 

 

DATE

 

NOTIFIED

 

 

 

 

 

 

 

 

 

 

 

PM

 

 

 

E

 

 

 

 

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

CONTACT NAME / PHONE NUMBER

 

 

 

 

 

TYPE OF INJURY/ILLNESS

 

 

 

PART OF BODY AFFECTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

DID INJURY/ILLNESS EXPOSURE OCCUR ON EMPLOYER'S PREMISES?

 

TYPE OF INJURY / ILLNESS CODE

PART OF BODY AFFECTED CODE

 

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

U

 

DEPARTMENT OR LOCATION WHERE ACCIDENT OR ILLNESS EXPOSURE

 

 

ALL EQUIPMENT, MATERIALS, OR CHEMICALS EMPLOYEE WAS USING WHEN

 

 

 

 

OCCURRED

 

 

 

 

 

 

 

ACCIDENT OR ILLNESS EXPOSURE OCCURRED

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPECIFIC ACTIVITY THE EMPLOYEE WAS ENGAGED IN WHEN THE ACCIDENT OR

WORK PROCESS THE EMPLOYEE WAS ENGAGED IN WHEN ACCIDENT OR ILLNESS

R

 

ILLNESS EXPOSURE OCCURRED

 

 

 

 

 

 

EXPOSURE OCCURRED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

HOW INJURY OR ILLNESS / ABNORMAL HEALTH CONDITION OCCURRED. DESCRIBE THE SEQUENCE OF EVENTS AND INCLUDE ANY OBJECTS OR SUBSTANCES THAT DIRECTLY INJURED THE EMPLOYEE OR MADE THE EMPLOYEE ILL.

 

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CAUSE OF INJURY CODE

 

 

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

DATE RETURNED TO WORK

IF FATAL, GIVE DATE OF DEATH

WERE SAFEGUARDS OR SAFETY EQUIPMENT PROVIDED?

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WERE THEY USED?

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

PHYSICIAN / HEALTH CARE PROVIDER ( NAME & ADDRESS )

 

 

HOSPITAL ( NAME & ADDRESS )

 

INITIAL TREATMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

NO MEDICAL TREATMENT

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

 

 

 

 

 

 

 

 

 

MINOR: BY EMPLOYER

 

 

T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

 

 

 

 

 

 

 

 

 

MINOR CLINIC/HOSPITAL

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N

 

 

 

 

 

 

 

 

 

EMERGENCY CARE

 

 

 

T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O

WITNESSES ( NAME & PHONE # )

 

 

 

 

 

 

 

HOSPITALIZED > 24 HRS

 

 

 

 

 

 

 

 

 

 

 

FUTURE MAJOR MEDICAL/

 

 

T

 

 

 

 

 

 

 

 

 

 

 

H

 

 

 

 

 

 

 

 

 

LOST TIME ANTICIPATED

 

 

DATE ADMINISTRATOR NOTIFIED

 

DATE PREPARED

PREPARER'S NAME & TITLE

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NM WCA FORM E1.2

EQUIVALENT TO OSHA'S FORM 301

FORM IA-1 (7/02) © IAIABC 2002

 

Completion of this form is not an admission that the claim is compensable under the Workers’ Compensation Act.

 

NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION

Phone: (505) 841-6000

In-State Toll Free: 1-800-255-7965

FARMINGTON: 505-599-9746/1-800-568-7310

LAS CRUCES: 505-524-6246/1-800-870-6826

LAS VEGAS:

505-454-9251/1-800-281-7889

LOVINGTON: 505-396-3437/1-800-934-2450

Roswell:

505-623-3781

Santa Fe:

505-476-7381

FILING INSTRUCTIONS

PURPOSE: To report all alleged work-related injuries or illnesses resulting in more than 7 days of lost work or in death of the worker. This form is not an admission or denial by the employer as to whether the worker's alleged injury or illness is compensable, and must be

completed by the employer or the employer's representative.

WHEN TO FILE: This form must be filed within 10 days of knowledge of any alleged work-related injury or illness that results in more than 7 days of lost work. It must be filed even if the employer disputes the worker's claim of work-related injury or illness.

WHERE TO FILE: Mail the original form to the New Mexico Workers' Compensation Administration (Attention: Statistics) at the address on the front of this form. Copies must also be provided to the worker and the employer's workers' compensation insurer.

PENALTIES: Each instance of failure to file this form when required is punishable by a fine of up to $1,000.00.

INSTRUCTIONS FOR COMPLETION

FILLING IN THE SHADED AREAS IS OPTIONAL. The employer may wish, however, to use some of these areas (such as "Witnesses") for the employer's records. Expanded instructions are found in the publication Guide to Completing the Employer's First Report of Injury or Illness, available from the Administration's Albuquerque office (call either number bold-faced above and ask for Statistics).

Please print in black ink or type, and ensure that all entries are legible before submission. An illegible or incomplete E1 may be returned.

NAIC CODE: Represents the nature of the employer's business at the location where the worker was employed at the time of injury or illness exposure; derived from the federal government publication North American Industry Classification System Manual. Include this code if known.

EMPLOYER'S LOCATION ADDRESS: Facility where the worker was employed at the time of injury, if different from mailing address.

CARRIER: Name, mailing address and telephone number of the licensed business entity issuing a contract of insurance and assuming financial responsibility on behalf of the employer. A WCA-approved self-insured employer should enter its business name.

CLAIMS ADMINISTRATOR: Name, mailing address and telephone number of the insurance carrier, agency, third party administrator or self-insured responsible for adjusting the claim.

EMPLOYER, CARRIER OR ADMINISTRATOR FEIN: Federal Identification Number, assigned by the Internal Revenue Service.

DID SALARY CONTINUE? Shows if the employer is continuing to pay the worker's regular wages without charge to employee benefits.

DATE OF INJURY/ILLNESS: In the case of an occupational illness (arising from the worker's activity or exposure over an extended period), enter the date of diagnosis or the date first reported to the employer as possibly work-related.

DATE EMPLOYER NOTIFIED: The date the worker first notified (verbally or in writing) the employer or the employer's representative of the alleged work-related injury or illness.

DATE DISABILITY BEGAN: The first full day on which the worker lost time from work due to the injury or illness.

TYPE OF INJURY OR ILLNESS: Briefly describe the nature of the injury (such as lacerations to the forearm) or illness (such as carpal tunnel syndrome). Be as specific as possible.

PART OF BODY AFFECTED: The specific part of body affected by the injury or illness (for example, right forearm, lower back).

DEPARTMENT OR LOCATION: If the accident or illness exposure did not occur on the employer's premises, enter specific address or location (for example, Client's office at 123 Main St., Yourtown, NM 87xxx). For occurrences in New Mexico, give ZIP or COUNTY.

ALL EQUIPMENT, MATERIAL OR CHEMICALS: List all equipment, materials and/or chemicals the worker was using, applying, handling or operating when the injury or illness exposure occurred. Be specific (for example, decorator's scaffolding, electric sander, paintbrush and paint). Enter "NA" if not applicable. NOTE: The items listed do not have to be directly involved in the worker's injury or illness.

SPECIFIC ACTIVITY: Describe the specific activity the worker was engaged in when the accident or illness exposure occurred (for example, sanding ceiling woodwork in preparation for painting).

WORK PROCESS: Describe the work process the worker was engaged in when the accident or exposure occurred, such as building maintenance. Enter "NA" for not applicable if not engaged in a work process (for example, if the worker was walking along a hallway).

HOW INJURY OR ILLNESS OCCURRED: Describe how the injury or illness/abnormal health condition occurred. Be very specific. Include the sequence of events and name any objects or substances that directly injured the worker or made the worker ill. (For example: worker stepped back to inspect work and slipped on some scrap metal. As worker fell, worker brushed against the hot metal.)

WORKER'S/EMPLOYER'S RIGHTS AND RESPONSIBILITIES

If you, the worker, believe that benefits are due you under the Workers' Compensation Act, and your employer or the employer's insurance carrier has failed or refused to make those benefits available to you, you have a right to file a complaint with the New Mexico Workers' Compensation Administration. Workers and employers with questions about rights or responsibilities under the Act may contact an ombudsman at any Workers' Compensation Administration regional office for information and assistance. To do so, call any of the above-listed telephone numbers (8 a.m. to 5 p.m. M-F).

Documents used along the form

When dealing with workplace injuries or illnesses in New Mexico, several forms and documents accompany the New Mexico Report form. Each of these documents plays a critical role in ensuring that the necessary information is communicated effectively between employers, employees, and insurance providers. Below is a list of important forms often used in conjunction with the New Mexico Report form.

  • Workers' Compensation Claim Form: This form is submitted by the employee to formally initiate a claim for workers' compensation benefits. It provides essential details about the injury or illness and the circumstances surrounding it.
  • Medical Authorization Form: This document grants permission for the employer or insurance carrier to access the employee's medical records. It is crucial for verifying the nature and extent of the injury or illness.
  • Employee's Wage Statement: This form outlines the employee's wages prior to the injury. It helps determine the compensation amount the employee may be entitled to while they are unable to work.
  • Return to Work Form: After an employee has recovered, this document is completed by the healthcare provider to confirm that the employee is fit to return to their job. It may also specify any work restrictions.
  • Incident Report: Often completed by a supervisor or manager, this report provides a detailed account of the incident leading to the injury or illness. It serves as a record for the employer and can be useful in preventing future occurrences.
  • Witness Statements: These are written accounts from individuals who witnessed the incident. They can provide additional perspectives on how the injury occurred and help substantiate the employee's claim.
  • Employer's Report of Injury: This form is completed by the employer to document their perspective on the incident. It includes details about the employee, the injury, and any actions taken following the event.
  • Operating Agreement Form: To effectively manage an LLC, consider utilizing the crucial Operating Agreement form details for comprehensive operational guidance.
  • Safety Inspection Report: This report details any safety inspections conducted at the workplace. It can be relevant in determining whether proper safety measures were in place at the time of the incident.
  • Claim Closure Form: Once the claim has been resolved, this form indicates the closure of the claim and summarizes the final decisions made regarding benefits or compensations.

Understanding these forms and their purposes is essential for both employees and employers. They ensure that all parties are informed and that the process of addressing workplace injuries or illnesses is thorough and transparent. Proper documentation can significantly impact the outcome of a claim, making it crucial to handle these forms with care and attention.

Dos and Don'ts

When completing the New Mexico Report form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are nine important dos and don'ts to consider:

  • Do print clearly in black ink or type to ensure legibility.
  • Do provide complete and accurate information regarding the employer and employee details.
  • Do file the form within 10 days of becoming aware of the injury or illness.
  • Do include the date of injury or illness and the date the employer was notified.
  • Do describe the injury or illness in detail, specifying the type and part of the body affected.
  • Don't leave any required fields blank; incomplete forms may be returned for correction.
  • Don't submit the form without reviewing it for errors or omissions.
  • Don't assume that the form does not need to be filed if the injury or illness is disputed.
  • Don't forget to provide copies of the form to the worker and the employer's workers' compensation insurer.

Following these guidelines will help facilitate the processing of the report and ensure compliance with New Mexico's workers' compensation requirements.

Similar forms

The New Mexico Report form, specifically the Employer's First Report of Injury or Illness, shares similarities with several other important documents used in workplace injury reporting and management. Below is a list of eight documents that have comparable purposes or structures:

  • OSHA Form 301: This form is used by employers to report work-related injuries and illnesses. Like the New Mexico Report form, it captures details about the incident, the affected employee, and the nature of the injury or illness.
  • California DWC Form 1: This document serves as the "Employee Claim for Workers' Compensation Benefits" in California. It collects information about the employee, the incident, and the medical treatment received, similar to the New Mexico form.
  • Florida First Report of Injury: This form is required for reporting workplace injuries in Florida. It includes details about the employee, the injury, and the employer, paralleling the structure and purpose of the New Mexico Report.
  • Illinois Form 45: Known as the "Employer's Report of Injury," this document is used to report work-related injuries in Illinois. It gathers information about the incident and the employee, akin to the New Mexico form.
  • Texas DWC Form-1: This is the "Employee's Claim for Compensation for a Work-Related Injury" in Texas. It similarly collects information about the injury and the employee, making it comparable to the New Mexico Report.
  • New York C-2 Form: This form is used to report workplace injuries in New York. It includes information about the employee and the incident, much like the New Mexico Report form.
  • Nebraska First Report of Injury: This document serves to report work-related injuries in Nebraska. It captures details about the employee and the circumstances of the injury, similar to the New Mexico form.
  • California Motorcycle Bill of Sale: This form is essential for confirming the sale and transfer of ownership of a motorcycle. It details critical information about the motorcycle and the parties involved, making it vital for both buyers and sellers. For more information, visit Top Forms Online.
  • Workers' Compensation Claim Form (varies by state): Many states have their own specific claim forms that serve similar functions. These forms typically require details about the employee, the injury, and the employer, reflecting the structure of the New Mexico Report.

Each of these forms plays a crucial role in ensuring that workplace injuries are documented and addressed appropriately, providing necessary information for claims processing and compliance with state regulations.

↓ New Mexico Report PDF Form

Misconceptions

  • Misconception 1: The New Mexico Report form is only for severe injuries.

    • This form must be completed for any work-related injury or illness that results in more than 7 days of lost work or in the death of the worker. It is not limited to severe cases; even minor injuries that lead to time off work require reporting.

  • Misconception 2: Filing the report admits liability for the injury.

    • Completing this form does not imply that the employer accepts responsibility for the claim. It is simply a procedural requirement to report the incident, regardless of the employer's stance on the compensability of the claim.

  • Misconception 3: The report can be filed at any time.

    • The form must be filed within 10 days of the employer's knowledge of the injury or illness. Delays in filing can lead to penalties, emphasizing the importance of timely submission.

  • Misconception 4: Only the employer can file the report.

    • While the employer or their representative typically completes the report, the worker also has the right to be involved in the process. They can ensure that their perspective is included, which can be crucial for accurate reporting.