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Alabama First Report PDF Details

The Alabama First report, commissioned by the Business Council of Alabama (BCA), offers a detailed examination of Alabama's business climate. The report assesses the state's strengths and weaknesses with respect to its ability to promote and sustain economic growth. It also provides recommendations for improving the state's business climate. Overall, the findings suggest that Alabama is still in need of significant improvements if it wants to compete with other states in terms of attracting new businesses and creating jobs.

The table contains details about the alabama first report. You might like to study it just before submitting the gaps.

Question	Answer
Form Name	Alabama First Report
Form Length	1 pages
Fillable?	Yes
Fillable fields	108
Avg. time to fill out	21 min 55 sec
Other names	wcc form2, alabama first report of injury, alabama dhr report form, first report of injury alabama

12

Form Preview Example

THE USE OF THIS FORM IS REQUIRED UNDER THE PROVISIONS OF THE ALABAMA WORKMEN’S COMPENSATION LAW

WCC Form 2

Rev. 10/2012STATE OF ALABAMA

EMPLOYER’S FIRST REPORT OF INJURY

OR OCCUPATIONAL DISEASE

CLAIM REFERENCE

1. Insured Report Number

2. Filing Office Claim Number

3. OSHA Log Case Number

EMPLOYER

4. Employer Business Name

ADDRESS, IF LOCATION DIFFERENT FROM BUSINESS ADDRESS

5. Physical Address 1

10. Mailing Address 1

6. Physical Address 2

11. Mailing Address 2

7. City

8. State

9. Zip

12. City

13. State

14. Zip

15. Federal ID Number

16. U.C. Account Number

17. NAICS

INSURER / FILING OFFICE

18.

Insurer Name

21. Filing Office Name

22. Mailing Address 1

19.

Insurer Federal ID Number

23. Mailing Address 2 or Telephone Number

24. City

25. State

26. Zip

20.

Type Insurer

Ins Co

Self-Insurer

Group Fund

27. Filing Office Federal ID Number

EMPLOYEE / WAGES

28. First Name

32. Employee ID Number

29. Middle Name

33. Type Employee ID Number

30.

Last Name

SSN

Passport Number

Green Card

31

Last Name Suffix

(ie. Jr., Sr., III)

Employment Visa

Assigned by Jurisdiction

34.

Mailing Address 1

40. Gender

41. Date of Birth

35.

Mailing Address 2

Male

36.

City

37. State

38. Zip

39. Phone

Female

42.Nbr of Dependents

43.

Marital Status

44. Date Hired

Unmarried (Single or Divorced or Widowed)

Married

Separated

Unknown

45.

Occupation Description

46. Number of Days Worked Per Week

47.

Wages $

49. Received Full Pay For Day of Injury?

Yes

No

48. Hourly

Daily

Weekly

Bi-weekly

Monthly

50. Did Salary Continue?

Yes

No

INJURY / TREATMENT

51.

Date of Injury

52. Time of Injury

53. Time Employee Began Work

54. Date Disability Began

55. Date of Death

a.m.

p.m.

unk

a.m.

p.m.

PLACE OF ACCIDENT, INJURY, OR EXPOSURE

61. Injury Occurred on Employer’s Premises?

56.

Site Address

Yes

No

57.

City

58. State

59. Zip

62. Date Employer Notified

60.

County

63. DESCRIBE WHAT THE EMPLOYEE WAS DOING JUST BEFORE THE INCIDENT AND HOW THE INJURY OCCURRED. ( Ex. While climbing a

ladder and carrying roofing materials, ladder slipped on wet floor causing worker to fall 20 feet.)

PROVIDE DESCRIPTION CODES to identify Nature of Injury, Part of Body that was affected, and Cause of Injury.

	(FOR COMPLETE LIST OF CODES, GO TO HTTP:// LABOR.ALABAMA.GOV/WC
64. Nature of Injury Code		65. Part of Body Code				66.		Cause of Injury Code
67. Initial Treatment	No Medical Treatment		68.	Name of Treatment Facility
First Aid By Employer	Minor Clinic / Hospital		68.	Name of Treatment Facility
First Aid By Employer	Minor Clinic / Hospital		69.	Address
Emergency Room	Hospitalized Overnight		69.	Address
Emergency Room	Hospitalized Overnight		70.	City		71. State			72. Zip
Hospitalized > 24 Hours	Outpatient Treatment		70.	City		71. State			72. Zip
Hospitalized > 24 Hours	Outpatient Treatment
73. Name of Physician or Other Health Care Professional					74. Has Injured Returned to Work			If so, 75. Date
					Yes	No		76. Time	a.m. p.m.

OTHER

77. Date Prepared

78. Preparer’s First Name

79. Last Name

80. Title

81. Preparer’s Telephone Number

03/01/2006

How to Edit Alabama First Report Online for Free

We were building the PDF editor having the idea of allowing it to be as quick to work with as it can be. That's why the actual procedure of completing the first report of injury form alabama will undoubtedly be simple perform these steps:

Step 1: Click the button "Get form here" to get into it.

Step 2: So you should be on your form edit page. You can include, adjust, highlight, check, cross, include or remove fields or text.

The next sections are what you will need to prepare to have the finished PDF form.

completing state of alabama first report of injury form step 1

You should provide your data in the part Bi, weekly Separated, Married, Monthly, Weekly, Daily, Unknown, un, k INJURY / TREATMENT 53, and PLACE OF ACCIDENT.

state of alabama first report of injury form Bi-weekly, Separated, Married, Monthly, Weekly, Daily, Unknown, unk, INJURY / TREATMENT 53, and PLACE OF ACCIDENT blanks to fill

It is vital to write down some information within the section (FOR COMPLETE LIST OF CODES, If so, and OTHER.

state of alabama first report of injury form (FOR COMPLETE LIST OF CODES, If so, and OTHER fields to fill

Step 3: When you are done, press the "Done" button to export the PDF document.

Step 4: In order to avoid potential upcoming challenges, it's recommended to have no less than two duplicates of each separate file.

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