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AL DoL WCC Form 2 2012-2025 free printable template

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WCC Form 2 Rev. 10/2012 THE USE OF THIS FORM IS REQUIRED UNDER THE PROVISIONS OF THE ALABAMA WORKMEN S COMPENSATION LAW STATE OF ALABAMA EMPLOYER S FIRST REPORT OF INJURY OR OCCUPATIONAL DISEASE CLAIM REFERENCE 2. Filing Office Claim Number 1. Insured Report Number 3. OSHA Log Case Number EMPLOYER ADDRESS IF LOCATION DIFFERENT FROM BUSINESS ADDRESS 10. Mailing Address 1 12. City 13. State 14. Zip 8. State 9. Zip 16. U. C. Account Number 17. NAICS 4. Employer Business Name 5. Physical Address...
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How to fill out AL DoL WCC Form 2

01
Obtain a copy of the AL DoL WCC Form 2 from the Alabama Department of Labor website or your employer.
02
Fill in your personal information at the top of the form, including your name, address, and contact information.
03
Provide details of the injury or illness, including the date it occurred and how it happened.
04
Include information about your employer, such as the company's name, address, and phone number.
05
Indicate whether you have received any medical treatment and provide details of medical providers if applicable.
06
Complete the section regarding lost wages, including your earnings prior to the injury and how it has impacted your ability to work.
07
Review all entries for accuracy and completeness.
08
Sign and date the form before submitting it to the appropriate office or your employer.

Who needs AL DoL WCC Form 2?

01
Workers who have suffered a workplace injury or illness in Alabama and are seeking workers' compensation benefits.
02
Employers who need to report workplace injuries or illnesses for compliance with Alabama workers' compensation laws.
03
Insurance companies that may require the form for processing workers' compensation claims.

Who uses the WCC Form 2?

An employer, whose employee sustained an industrial injury as a result of an incident, should use this form to report the injury or occupational disease.

What is the purpose of the WCC Form 2?

The WCC Form 2 is a first report of injury or occupational disease.

When is the WCC Form 2 due?

The form must be submitted within 10 days after the date of receipt of notice of knowledge of death or injury.

What information should be provided?

The employer should provide the following information.

Section Employer: employer’s business name, physical and mailing addresses.

Section Insurer/Filing Office: Insurer’s name, federal ID number, type, filing office name, mailing addresses, filing office federal ID number.

Section Employee/Wages: employee’s full name, ID number, SSN, passport number, mailing addresses, gender, date of birth, number of dependents, marital status, date when hired, occupational description, number of working days per week, wages.

Section Injury/Treatment: date of injury, time of injury, time the employee began work, date disability began, date of death, place of accident, injury or exposure, description of the work the employee was doing just before the accident and how injury occurred, description codes to identify the nature of injury, part of body that was affected, and cause of injury, information about initial treatment, name and address of the treatment facility, name of physician or other health care professional. The employer has to answer whether the employee has returned to work, date and time of return.

Section Other: date of the form preparation, the preparer’s name, title and telephone number.

Where do I send the WCC Form 2?

The WCC Form 2 must be sent to the employer’s worker’s compensation insurance carrier and to the Worker’s Compensation Commission.

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People Also Ask about alabama report form

New Hire Paperwork: Alabama Alabama employers must obtain a completed Form A-4, Employee's Withholding Tax Exemption Certificate, from each employee. Alabama does not accept the federal Form W-4. Employers must provide notice to new hires regarding misrepresentations with respect to workers' compensation benefits.
Here are some of the forms required for hiring new employees: W-4 (or W-9) form. The W-4 form tells employers how much money the employee wants to withhold from their pay for the correct federal tax income. I-9 form. State tax withholding form. Direct deposit form. Internal forms. Personal data for emergencies form.
2021 Alabama Individual Income Tax Return (Form 40) - Alabama Department of Revenue.
Reporting Requirements Employers who fail to report newly hired or recalled workers may be fined up to $25 for each violation. All reports of hire will require the following data: employee's name, address, and social security number; first day of work; and, whether the employee was newly hired or recalled to work.
Please call your County Department of Human Resources or local law enforcement agency to report suspected abuse or neglect. Do not send reports of suspected abuse or neglect via email. Alabama law is clear on reporting abuse and neglect of children under the age of 19. The age of the majority in Alabama is now 19.

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AL DoL WCC Form 2 is a form used in the state of Alabama to report certain data related to workers' compensation claims. It is a part of the administrative procedures for ensuring compliance with workers' compensation laws.
Employers in Alabama who have employees covered by workers' compensation insurance are required to file AL DoL WCC Form 2 to report claims or incidents related to workplace injuries.
To fill out AL DoL WCC Form 2, you need to provide details such as the employer's information, employee's information, details of the accident or injury, medical treatment provided, and any other pertinent information related to the claim.
The purpose of AL DoL WCC Form 2 is to facilitate the reporting and tracking of workers' compensation claims, ensuring that all necessary information is documented for processing claims in accordance with Alabama's workers' compensation laws.
Information that must be reported on AL DoL WCC Form 2 includes the employer's name and address, employee's name and address, date of the injury, type of injury, date of report, medical treatment details, and any insurance information relevant to the claim.
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