First Report of Injury
Welcome to the Workers' Compensation First Report of Injury Web Application. This application allows an insurance carrier, self-insured employer, or their contracted third party administrator to file a First Report of Injury via the Internet. If you have a workers’ compensation insurance policy, you must provide the injury information to the carrier or their agent. If your carrier is the State Workers' Insurance Fund (SWIF)
refer to the proper reporting procedures for Reporting an Injury or Occupational Disease
To file via the Internet, you must first obtain a userid and password. Once the application for a userid and password is completed online, it should be printed then faxed or mailed to the Bureau of Workers' Compensation for analysis and approval. We are committed to a 5-day turnaround time on the approval of applications. Click here to obtain your userid and password
. If you are unable to access the application using the free Adobe Acrobat Reader
, please contact us at (717) 772-0621 for a hard copy of this application.
The instructions provided on the next page contain valuable information that, if read thoroughly, will lead to successful electronic submission of the First Report of Injury. Navigation throughout the application should be done by clicking the provided buttons ONLY.
For your security, this site requires a browser with support for SSL (Secure Sockets Layer) 128-bit encryption. Detailed instructions are provided by each vendor. After downloading, you will need to exit your current browser in order to install the new one.