First Report of Injury
The Virginia Workers’ Compensation Act requires that ALL injuries occurring in the course of
employment be reported to the Commission pursuant to Va. Code §65.2-900.
The employer is responsible for accurately completing all sections of this form when an employee is
injured. It should be typed or legibly printed, signed, and dated by the preparer. Send the original
form to the claim administrator for the insurance company who provided insurance coverage on the
date of the occurrence. The claim administrator will report this information to the Commission.
Contact your workers’ compensation insurance provider for additional information.
Claim administrators who are EDI enabled will use the information contained on the paper form and
submit electronic data to the Commission.
Claim administrators who are NOT EDI enabled must immediately file the completed form with the
Commission. Please note: EDI is mandatory no later than June 30, 2009, after which time paper
reports will no longer be accepted. Until you are in EDI production, mail the completed form to the
Virginia Workers’ Compensation Commission, 1000 DMV Drive, Richmond, VA 23220. At the top of the
form, use a numerical code (1-7) to indicate the reason for filing the form for accidents meeting one of
the filing criterion.* If none of the criteria apply, you must still report the accident, but may use either
Form 45A or this form to do so. (Leave “reason for filing” blank in such a case.)
For questions or assistance in completing the form, please contact the Commission toll-free at 877-664-
submissions or payments made via this website do not constitute a
binding agreement to your policy or coverages. Changes and
payments to policies are not effective or binding until you, or any
party involved, receive official notice from either your insurance agent,
or your insurance company. If you have any questions, please feel free to
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