Employee’s Report of Injury (SORM29)

* NOTE: Use the free program, Adobe Acrobat, to open PDFs.


Required:
This form should always be filled out by the injured employee and filed with SORM. This will help to expedite benefits in a more timely manner.

Filing Deadline:
The form must be received by SORM not later than the 5th calendar day after the First Report of Injury or Illness (DWC-1S) is reported to the agency.

Completed by:
The claimant, with assistance from the claims coordinator.

Instructions:
All fields should be completed in detail and printed legibly. Make sure that the claimant signs and dates the bottom of the form.

Distribution:
Fax a copy or mail the original to:
State Office of Risk Management

Retain a copy for your file.