Notice of Injury

Instructions for Filling Out the Workers' Compensation First Report of Injury or Illness (IC1A-1)

The form should be filled out by the employer or a representative; however, the injured employee may fill out the form if necessary.
Complete all non-shaded areas with as much detail as possible.
Distribute copies of the completed form as follows:
The original to the Idaho Industrial Commission, PO Box 83720, Boise, Idaho 83720-0041. (If the form is completed by the injured employee, an additional copy should be sent to the Industrial Commission. The Commission will then send a copy to the adjuster.)
One copy to the employer's workers' compensation insurer or adjuster.
One copy retained for the employer's files.
The Idaho Industrial Commission can answer questions or provide helpful information for injured workers and guidelines for employers. For more information, please contact the Idaho Industrial Commission at (208) 334-6000 or http://www.iic.idaho.gov/.