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Illinois Form 45

Illinois Form 45: Employer's First Report Of Injury

Please fill out immediately and take as many photos as possible.

  • MM slash DD slash YYYY
  • Employee's Personal Information

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Accident Information

  • :
  • MM slash DD slash YYYY
  • :
  • MM slash DD slash YYYY
  • Drop files here or
    Max. file size: 256 MB.
      Please upload all pictures taken of accident. Injuries, conditions of workplace, etc.