Form 04-0101 Employer's Report of Industrial Injury Form - Arizona

What Is Form 04-0101?

This is a legal form that was released by the Industrial Commission of Arizona - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the Form 04-0101 Employer's Report of Industrial Injury Form?
A: The Form 04-0101 is a report form used by employers in Arizona to report industrial injuries.

Q: Who needs to fill out the Form 04-0101 Employer's Report of Industrial Injury Form?
A: Employers in Arizona who have employees that sustain an industrial injury must fill out this form.

Q: What is the purpose of the Form 04-0101 Employer's Report of Industrial Injury Form?
A: The form allows employers to report any industrial injuries that occur in the workplace.

Q: What information is required on the Form 04-0101 Employer's Report of Industrial Injury Form?
A: The form requires information about the injured employee, the nature of the injury, and details about the incident.

Q: Is the Form 04-0101 Employer's Report of Industrial Injury Form mandatory?
A: Yes, employers in Arizona are required to fill out this form when an employee sustains an industrial injury.

Q: Are there any deadlines for submitting the Form 04-0101 Employer's Report of Industrial Injury Form?
A: Yes, the form must be submitted within 10 days after the employer has knowledge of the injury.