Marcia Hultman

Cabinet Secretary

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Workers' Compensation

First Report of Injury

You may file your First Report of Injury (Form 101), your Monthly Payment Reports (Form 107) and a Request for Extension of Time online using the First Report of Injury Management System.

Filing Online using the First Report of Injury Management System

(for insurance companies only)

If you are doing simple online data entry, all you need is a user id and a password. These can be obtained by emailing or calling the Division of Labor and Management at 605.773.3681.

If you want to do a bulk file transfer of these forms, you will need a user id, a password and initial transfer testing. Email or call the Division of Labor and Management at 605.773.3681 to arrange for testing.

Instructions for using the online system are in the Claim Administrators documentation (Adobe PDF format).

First Report of Injury Management System

Fillable Adobe PDF First Report of Injury Form

(for employees and employers only)

Another option for completing the First Report of Injury (Form 101) is to complete a fillable Adobe PDF file on the computer, then print and mail it to us, following the instructions on page 2 of the form.

First Report of Injury - fillable Adobe PDF format