FIRST REPORT OF INJURY OR ILLNESS - Lake County, Florida ...
FLORIDA DEPARTMENT OF FINANCIAL SERVICES. DIVISION OF WORKERS' COMPENSATION. For assistance call 1-800-342-1741. or contact your local EAO Office . Report all deaths within 24 hours . 1-800-219-8953 or 1-850-922-8953 PLEASE PRINT OR TYPE. EMPLOYEE INFORMATION (Fill in Shaded Areas) Name (First, Middle, Last): Social Security Number: - - ................
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