FIRST REPORTS OF INJURY CAN ONLY BE FILED ONLINE
VIA A DIA ONLINE ACCOUNT

 

Apply For A DIA Online Account You will receive an email with your login and password within a few days of your request. You will also receive instructions on the use of the account and all its features.

Login For Existing Electronic DIA Accounts

 

The First Report of Injury (Form 10)1 should be filled out when an employee is injured, or alleges an injury, and is unable to earn full wages for five or more calendar days (Mondays through Sundays). It is the responsibility of the employer to report an alleged injury, whether or not the employer agrees with the employee's claim or not.

This form must be filed within seven (7) calendar days (not counting Sundays and legal holidays), from the fifth day of disability.

Once you have completed the electronic First Report of Injury (Form 101), you should print out a copy for your records  You should make three (3) additional copies:

  • One for the employee.
  • One for your insurance company.
  • One for your own records.