Report An Injury

How to Report an Accident/Injury

1. Within 24 hours of accident, injury or illness – via FHM web site, call or fax a completed First Report of Injury or Illness to FHM.
   1. Submit Online or
   2. Fax to (407-352-5788) or
   3. Call 888-346-3461, Ext. 353
2. Have the following information ready:
   1. Injured employee information:
      1. Full name, address and telephone number;
      2. Occupation, date of birth and sex;
      3. Social Security number; and
      4. Hire date
   2. Date and time of accident.
   3. Employee’s description of accident.
   4. Injury/illness that occurred, part of body injured.
   5. Company name, telephone and address.
   6. Employer’s location address if different from above.
   7. Place/address accident/injury occurred.
   8. Federal Employer ID# and FHM policy number; (i.e., 306 –xxxx).
   9. Did the employee return to work?
   10. Do you (the employer) agree with the accident?
   11. Name of physician or hospital where employee was sent by you for treatment.