Employer's First Report of Injury

Welcome to the State of New Hampshire's workers' compensation employer's first report of injury filing process. RSA 281-A:53 requires employers to report any injury sustained by an employee in the course of employment as soon as possible, but no later than 5 days after the employer learns of the occurrence of such an injury. Employers may elect to report directly to the Department. To do so, employers should download either the PDF or Word version of the form and provide to the Department by mail, fax, or email as outlined below.

Download the Adobe PDF version of the form
Download the Microsoft Word version of the form

Fax Number: (603) 271-0126
Email: FirstReport@dol.nh.gov

Mailing Address:

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

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.