Form Oic Wc 2 – Fill Out and Use This PDF

Form Oic Wc 2 is an essential document for employers and employees across the nation. It allows businesses to accurately record employee hours and set up payrolls that ensure everyone is being paid as accurately and quickly as possible. The form provides entities with important information about their directors, officers and business owners that must be accurately filled out in order for the document to comply with regulations of wage determination systems at the local, state, and federal level. Not only does Form Oic Wc 2 provide applicable taxes on wages, but it also corroborates sales made by businesses over a certain amount. Completing the necessary elements used for this document are required for filing required IRS forms on time as well such as 941 or 945 plan documents.

Form Oic Wc 2 PDF Details

Are you looking for a new job? Have you ever considered working for the federal government? If so, you may be interested in Form Oic Wc 2. This is a form that allows you to apply for a job with the federal government. It is important to note that not all jobs are listed on this form. Instead, it contains a list of vacancies that are currently open. If you are interested in any of these positions, be sure to submit your application before the deadline. Thanks for reading!

Question	Answer
Form Name	Form Oic Wc 2
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	west virginia form disease, wv occupational disease, oic wc 2, how to west virginia report injury

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Form OIC-WC-2

West Virginia Workers’ Compensation

Employers’ Report of Occupational Injury or Disease

PLEASE PRINT OR TYPE

Section I	Employer Information
Insurer:		Third-Party Administrator:

Employer’s Name:	Nature of Business:		FEIN:

Address:

City:

State:

Zip:

Telephone: ( ) -

Section II

Employee Information

Name: (Last):

(First):

(M.I.):

Occupation/Job Title:

Address:

Telephone: (

)

City:

State:

Zip:

Social Security No.:

Date of Birth:

6. Sex:

Marital Status:

Injured Employee is (check all that apply):

Full-Time

Part-Time

Volunteer

Employee’s Occupation/Job Title:

Owner/Partner

Officer

Retired – Date Retired:

Section III

Information Regarding Injury or Disease

Date of Injury or Last Exposure:

Time:

a.m.

p.m.

Date Employer Notified of Injury

Supervisor to whom Injury or Disease

or Disease:

Reported:

If Injury was Fatal, Indicate Date of Death:

Did Injury Occur on Employer’s Property?

Yes

No Address or location where injury

occurred:

Witnesses to Injury:

What was the Employee Doing when Injury Occurred (loading truck, walking down stairs, etc.):

How did the Injury or Disease Occur (be specific; include time that employee began work on the date of injury, any equipment, tools, substances or objects connected to the injury; attach additional sheet if necessary):

Nature of Injury or Disease (cut, bruise, strain, etc.):

Body Part(s) Injured:

Are You Aware of, or Do You Suspect, a Prior Injury to this Body Part?			Yes	No

Do You Have Reason to Question this Injury?	Yes	No	(If “yes,” attach a specific explanation to this form).

Location of Initial Treatment:			Emergency Room?	Yes	No	Hospitalized?	Yes	No

Section IV

Wage and Lost Time Information

Date Hired:

Last Day Worked After Occupational Injury or Disease:

Number of Work Days Lost:

Date of Return to Work:

Hours Worked per Week:

Is Light Duty Available?

Yes

Wage on Date of Injury: $

per

hour

day

week

month

Are Wages Being Paid to Injured Employee

If Employee has Returned to Work, is it Alternative or Modified Work?

Yes

During Disability?

Yes

If “yes,” indicate current wage: $

per

hour

day

week

month

Daily rate of pay on the date of injury: $

and best quarter wages of preceding four quarters $

I certify the statements and answers set forth in this section are true and correct to the best of my knowledge. I am aware the law, specifically West Virginia Code §61-3-24e, provides for severe penalties if I knowingly certify a false report or statement and/or withhold a material fact regarding any information requested. I acknowledge the provisions of the aforementioned code and the severe penalties for knowingly with fraudulent intent aiding or abetting anyone in securing or attempting to secure benefits to which he or she is not entitled.

Print Name:		Title:

Signature:	_____________________________________________	Date:	_______/________/________

How to Edit Form Oic Wc 2 Online for Free

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1. Begin completing your west virginia workers compensation disease with a number of essential blank fields. Note all the important information and ensure not a single thing missed!

Filling out section 1 in wv report injury

2. Once the previous section is completed, you need to insert the essential details in If Injury was Fatal Indicate Date, Did Injury Occur on Employers, Yes, No Address or location where injury, What was the Employee Doing when, How did the Injury or Disease, Nature of Injury or Disease cut, Body Parts Injured, Are You Aware of or Do You Suspect, Yes, Do You Have Reason to Question, Yes, No If yes attach a specific, Location of Initial Treatment, and Emergency Room allowing you to go to the third step.

What was the Employee Doing when, How did the Injury or Disease, and Yes in wv report injury

3. This part will be hassle-free - fill out every one of the empty fields in I certify the statements and, Print Name, Signature, Title, and Date in order to finish the current step.

Signature, Date, and Title in wv report injury

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Form Oic Wc 2 – Fill Out and Use This PDF

Form Oic Wc 2 PDF Details

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