Employers First Report of Injury

Welcome to the State of New Hampshire's workers' compensation employer's first report of injury filing process. We are in the process of redesigning the website and migrating it to the State's NH.gov server. The online applications are not yet available on the new site. In the interim, we request you follow the process below. Thank you for your patience.

There are presently two options for completing the Employer's First Report of Injury form and filing it with NH Department of Labor.

Option One: Download the Adobe PDF version of the form , print it, complete it manually and either fax or mail it in. See the fax and mailing address below.

Fax Number: (603) 271-0126

Mailing Address:

Workers' Compensation Division
NH Department of Labor
95 Pleasant Street
Concord, NH 03301

Option Two: Download the Microsoft Word version and complete it electronically and email it to WorkersComp@dol.nh.gov. To use this option, you must have Microsoft Word on your personal computer.

The Department of Labor does not report any of the information or data filed on this form to the employer's workers' compensation carrier. The responsibility of filing a workplace injury claim with the employer's workers compensation carrier remains with the employer or self insurer.