Form — First Report of Injury or Illness (FROI) — 14-0001

Description: 

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Name

First Report of Injury or Illness (FROI)

Number

14-0001

Updated

June 2022

Overview

An employer or the employer's representative must file with DWC a FROI in case of occupational:

  • Fatality,
  • Permanent disability, or
  • Temporary disability lasting more than three days.

An employer or the employer's representative must file a FROI:

  • Within four days of the event; and
  • If the employee claims the disability is caused by work even if the employer or employer's representative disagrees.

Records & Reports

Every employer must keep a record of all injuries sustained by employees in the course of their employment resulting in incapacity for longer than one day.

All books, records, and payrolls of an employer must be open for inspection by the Iowa Workers' Compensation Commissioner for purposes of administering the Iowa Workers' Compensation Act.

An employer must furnish to an employee upon request one statement of earnings, wages, or salary for the year preceding the injury. An employer may be subject to a civil penalty of one thousand dollars ($1,000.00) per offense for failure to furnish such wage statement.

Civil Penalty

The Commissioner may require an employer to appear and show why the employer should not be subject to a civil penalty of one thousand dollars ($1,000.00) per occurrence for failure to comply with the reporting or inspection requirements.

Upon hearing, if the facts indicate, the Commissioner may enter an order requiring payment of such penalty.

Unless voluntarily paid, the Commissioner may petition the district court for entry of judgment on the order.

The employer's insurance carrier shall be responsible in the same manner and to the same extent as the employer when a report of injury has been submitted to the employer's insurance carrier and not filed by it with DWC.

Additional Reporting Requirements for Iowa OSHA

Additional reporting and recordkeeping requirements may apply to the incident described in the FROI.

For information about Iowa OSHA reporting requirement, click here.