Get Illinois 45 Form

The Illinois Form 45 is the Employer's First Report of Injury, which employers must complete to report work-related injuries or illnesses. This form collects essential information about the incident, including details about the employee, the nature of the injury, and the circumstances surrounding the accident. For employers, accurately filling out this form is crucial for compliance with state regulations.

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The Illinois Form 45, known as the Employer's First Report of Injury, serves as a crucial document for employers when reporting workplace injuries. This form captures essential information about the incident, including the employer's details, the employee involved, and the circumstances surrounding the injury. Employers must indicate whether the case involves lost workdays and provide specific data about the employee, such as their name, Social Security number, and job title. The form also requires a description of the accident, including the nature of the employee's activities at the time and the injury sustained. Additionally, it prompts employers to disclose the medical treatment received, including any emergency care or hospitalization. By law, accurate record-keeping of work-related injuries is mandatory, particularly for those resulting in more than three lost workdays. While the completion of this form is a legal requirement, it is important to note that filing it does not imply liability under the Workers' Compensation Act. The information collected is confidential, emphasizing the importance of protecting the privacy of all parties involved.

Document Breakdown

Fact Name	Description
Purpose	The Illinois Form 45 is used by employers to report work-related injuries or illnesses to the Illinois Workers' Compensation Commission.
Governing Law	This form is governed by the Illinois Workers' Compensation Act, which mandates reporting of certain injuries.
Lost Workdays	Employers must indicate if the case involves lost workdays, as this affects reporting requirements.
Confidentiality	Information submitted on this form is confidential and cannot be used against the employer in legal proceedings.
Record Keeping	Employers are required to maintain accurate records of all work-related injuries, except for minor injuries.
Submission	The completed form must be sent to the Illinois Workers' Compensation Commission at the specified address.

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Misconceptions

Misconceptions about the Illinois Form 45 can lead to confusion for employers and employees alike. Below is a list of common misunderstandings regarding this important document.

Misconception 1: The Form 45 is only required for serious injuries.

This is incorrect. Employers must file the Form 45 for any work-related injury that results in the loss of more than three scheduled workdays, regardless of the injury's severity.

Misconception 2: Filing the Form 45 admits liability for the injury.

In reality, submitting this form does not imply that the employer accepts liability under the Workers' Compensation Act. It serves merely as a report of the incident.

Misconception 3: The information on the Form 45 is not confidential.

This is false. The information provided is confidential and is protected by law, ensuring that personal details about the employee are not disclosed publicly.

Misconception 4: Only the employee can fill out the Form 45.

Employers are responsible for completing the form. However, they may consult with the employee for accurate details regarding the incident.

Misconception 5: The Form 45 must be submitted immediately after an injury occurs.

While prompt reporting is encouraged, employers are required to submit the form within a specific time frame after the injury, typically within a few days.

Misconception 6: The Form 45 is not necessary if the employee returns to work quickly.

This is misleading. If an employee loses more than three scheduled workdays, the form must still be filed, regardless of how quickly they return to work.

Misconception 7: The Form 45 can be submitted electronically.

Currently, the form must be sent in hard copy to the Illinois Workers' Compensation Commission. Electronic submissions are not permitted.

Misconception 8: The information on the Form 45 is only relevant for the employer.

In fact, the information is also vital for the Illinois Workers' Compensation Commission and may be used in the determination of benefits for the injured employee.

Example - Illinois 45 Form

ILLINOIS FORM 45: EMPLOYER'S FIRST REPORT OF INJURY

Please type or print.

Employer's FEIN

Employer's name

Date of report

Case or File #

Is this a lost workday case?

Yes / No

Doing business as

Employer's mailing address

Nature of business or service

SIC code

Name of workers' compensation carrier/admin.

Policy/Contract #

Self-insured?

Yes / No

Employee's full name	Social Security #	Birthdate

Employee's mailing address

Employee's e-mail address

		# Dependents	Employee's average weekly wage
Male / Female	Married / Single

Job title or occupation			Date hired

Time employee began work

Date and time of accident

Last day employee worked

If the employee died as a result of the accident, give the date of death.

Did the accident occur on the employer's premises?

Yes / No

Address of accident

What was the employee doing when the accident occurred?

How did the accident occur?

What was the injury or illness? List the part of body affected and explain how it was affected.

What object or substance, if any, directly harmed the employee?

Name and address of physician/health care professional

If treatment was given away from the worksite, list the name and address of the place it was given.

Was the employee treated in an emergency room?		Was the employee hospitalized overnight as an inpatient?
Yes / No		Yes	/ No

Report prepared by	Signature			Title and telephone #

Please send this form to the ILLINOIS WORKERS' COMPENSATION COMMISSION			701 S. SECOND STREET SPRINGFIELD, IL 62704. IC45 12/04

By law, employers must keep accurate records of all work-related injuries and illness (except for certain minor injuries). Employers shall report to the Commission all injuries resulting in the loss of more than three scheduled workdays. Filing this form does not affect liability under the Workers' Compensation Act and is not incriminatory in any sense. This information is confidential.

Dos and Don'ts

When filling out the Illinois Form 45, it is essential to follow certain guidelines to ensure accuracy and compliance. Here are four things to do and four things to avoid.

Do type or print clearly to ensure legibility.
Do provide accurate information regarding the employee’s details, including their full name and Social Security number.
Do specify the nature of the injury and how it occurred, as this information is critical for processing the report.
Do submit the form to the Illinois Workers' Compensation Commission promptly after the incident.

Don't leave any required fields blank; incomplete information can delay processing.
Don't provide false information or misrepresent any details, as this can have legal consequences.
Don't forget to sign the form; an unsigned report may be considered invalid.
Don't delay the submission of the form, especially if the injury results in lost workdays.

Illinois 45: Usage Instruction

After gathering the necessary information, you can begin filling out the Illinois Form 45. This form is used to report workplace injuries to the Illinois Workers' Compensation Commission. Make sure to provide accurate details to ensure proper processing.

Type or print the employer's Federal Employer Identification Number (FEIN) at the top of the form.
Enter the employer's name and the date of the report.
Provide the case or file number, if applicable.
Indicate whether this is a lost workday case by selecting "Yes" or "No."
List the name the employer does business as (DBA) and the employer's mailing address.
Specify the nature of the business or service and include the Standard Industrial Classification (SIC) code.
Provide the name of the workers' compensation carrier or administrator and the policy or contract number.
Indicate if the employer is self-insured by selecting "Yes" or "No."
Fill in the employee's full name, Social Security number, and birthdate.
Enter the employee's mailing address and email address.
List the number of dependents and the employee's average weekly wage.
Select the employee's gender by marking "Male" or "Female."
Indicate the employee's marital status by selecting "Married" or "Single."
State the employee's job title or occupation.
Provide the date the employee was hired and the time they began work.
Enter the date and time of the accident.
State the last day the employee worked.
If applicable, provide the date of death if the employee died as a result of the accident.
Indicate whether the accident occurred on the employer's premises by selecting "Yes" or "No."
Provide the address where the accident occurred.
Describe what the employee was doing when the accident occurred.
Explain how the accident occurred.
Describe the injury or illness, including the part of the body affected and how it was affected.
Identify any object or substance that directly harmed the employee.
Provide the name and address of the physician or health care professional who treated the employee.
If treatment was given away from the worksite, list the name and address of that place.
Indicate if the employee was treated in an emergency room.
State whether the employee was hospitalized overnight as an inpatient by selecting "Yes" or "No."
Complete the report prepared by section with the preparer's signature, title, and telephone number.

Once the form is completed, it should be sent to the Illinois Workers' Compensation Commission at the specified address. Ensure that all information is accurate and complete before submission to avoid delays in processing.