Effective January 1, 2014, the Employer's First Report of Injury/ or Fatality - Form 101 can only be filed electronically with the DIA. Once the Form has been filled out online the employer should print three copies of the Employer's First Report of Injury or Fatality - Form 101: One (1) copy MUST be given to the employee; one (1) copy to your insurance company and keep one (1) copy for your records. This form must be electronically filed with the DIA within seven calendar days (not including Sundays and legal holidays) from the fifth full or partial day of disability. Submission of the form does not constitute an admission of liability.

You must apply for a login and password with the DIA to create an account if you do not already have one. To create login please go to using a log-in and password

If the form you submitted is incomplete or contains an error, it will be rejected by the DIA via an auto-rejection notice. In the comment screen of the notice the errors will be labeled. You will be asked to correct the information and resubmit. This will help you to avoid incurring a fine. If your submission is successful, you will receive a Transmittal ID Number. Please keep the Transmittal ID Number for your records.