First Report of Injury Forms

If the state where you were injured differs from your home address, please use the following guide to determine which State FROI form to use:

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1. State hired = Iowa

2. State you live ___________________

3. State injured ___________________

 

Choose the state that has 2 matches above. If all 3 responses are different, then choose the state you would anticipate the majority of

medical care to occur.