Alabama First Report – Fill Out and Use This PDF

Alabama First Report PDF Details

WCC Form 2 (Rev. 10/2012) is the official document for reporting workplace injuries and occupational diseases under Alabama workers' compensation law. Employers and their insurers complete this form to start the claims process and maintain a formal record of the incident.

Who Must File

All employers with workers' compensation coverage in Alabama must submit this form after any workplace injury or diagnosed occupational disease. The duty to file applies whenever an employee misses at least one day of work due to the incident. The form captures insured party details, employer and insurer identification, and the filing office information.

Filing Deadline

Alabama law requires employers to file the First Report of Injury within 15 days of learning about the incident. Late filing can result in penalties and may delay benefit payments to the injured worker. Keep a dated copy of the completed form for your records.

Key Sections of the Form

The form is organized into several required sections:

• Employer identification: business name, address, and insurer policy details
• Employee information: full name, job title, date of hire, and wage details
• Injury details: date, time, and exact location of the incident
• Nature and cause of injury using standard state description codes
• Body part affected and severity level
• Initial medical treatment: name and address of the treating facility
• Return-to-work status and projected return date

How to Complete the Form

Before filling out the form, gather the following information:

• Employee full name, job title, and hire date
• Date, time, and written description of the accident or exposure
• Name and contact details of any witnesses
• Name and address of the treating physician or hospital
• Employer workers' compensation policy number and insurer contact details

Complete every required field. Use standard injury description codes from the state coding manual. If a field does not apply, write "N/A" rather than leaving it blank. For related documentation, see the Workers' Compensation Injury Report.

Consequences of Incomplete Filing

Errors, missing fields, or late submission can cause claim delays and expose the employer to penalties under Alabama Code Title 25, Chapter 5. Review each section carefully before submitting to the insurer and to the Alabama Workers' Compensation Division.

Form Number and Alternative Names

The current version is WCC Form 2 Rev. 10/2012. Employers should always use the most current revision. Alternative names include: First Report of Injury Form Alabama, State of Alabama Employers First Report of Injury, and Alabama WCC Form 2.