FIRST REPORT OF INJURY OR ILLNESS TO BE COMPLETED BY INSURANCE CARRIER OR SELF-INSURED EMPLOYER Forms
| Form Name | FIRST REPORT OF INJURY OR ILLNESS TO BE COMPLETED BY INSURANCE CARRIER OR SELF-INSURED EMPLOYER |
| Form # | Form 122C |
| Form Revision | Rev 7/2024 |
| Category | Forms » First Report |
| Downloads | |
| Form State | Utah |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |