All employers must file an Employer's First Report of Injury or Fatality - Form 101, within seven (7) calendar days of receiving notice of any injury alleged to have arisen out of and in the course of employment that incapacitates an employee from earning full wages for a period of five (5) CALENDAR days.

Failure to file this report or filing of the report late is a violation under MGL c. 152, § 6. If this violation occurs three (3) or more times within any year, a fine of one hundred dollars ($ 100) for each such violation will be sent to the employer. A payment or appeal response is required within 30 calendar days as outlined on the Form 60 Notice. You will be notified when a decision is rendered. Failure to comply may escalate to various demand levels. There is no appeal process for demand notices.

Any questions on Demand Notice - Form 420 may be directed to Revenue Office x 617-626-5470.

Referral to Revenue Office terminates the involvement of the First Report Compliance Office.

Online First Report of Injury Payment


MANAGER

Janine Senatore
617-727-4900, x 7332