Complete all First Reports of Injury and Guest Liability Reports with the franchised corporations information and submit to the Insurance Agency. Include any witness statements and/or detailed explanation of event.
Vista Agency (attention: Jose or Isrrael) Contact information: (O) 847-255-5880 (F) 847-255-5897
The completed First Report of Injury and/or Guest Liability Report are to be faxed to the Insurance Agency @ 847-255-5897 and a copy with fax confirmation page to should be emailed to: HRsupport@flipmeastack.com
Any questions or complications with completing documentation. Please contact HRsupport@flipmeastack.com or call 855-569-4467.
Illinois - https://www2.illinois.gov/sites/iwcc/search/pages/results.aspx?k=first%20report%20of%20injury
Wisconsin - https://dwd.wisconsin.gov/dwd/forms/wkc/wkc-12-e.htm
Michigan - http://www.michigan.gov/documents/wca_WC-100__fillin_121830_7.pdf
Iowa - https://www.iowaworkcomp.gov/sites/authoring.iowadivisionofworkcomp.gov/files/First%20Report%20of%20Injury%2014-0001%20May%202015.pdf
Indiana - https://forms.in.gov/Download.aspx?id=4916
OSHA 300 and 301 Forms
Guest/Incident Liability Report Word
Guest/Incident Liability Report PDF
