Instructions for Filling Out the Workers’ Compensation First Report of 
                     Injury or Illness (IC1A-1) 
 
 1)  The form should be filled out by the employer or a representative; however, 
 the injured employee may fill out the form if necessary. 
 2)  Fill out non-shaded areas as completely as possible. 
 3)  Distribute copies of the completed form as follows: 
 
 • The original to: 
   Idaho Industrial Commission 
   PO Box 83720 
   Boise, ID  83720-0041 
   (If the form is completed by the injured employee, an additional 
   copy should be sent to the Idaho Industrial Commission.  The Idaho 
   Industrial Commission will then send a copy to the adjuster.)  The 
   PDF can be emailed to the Commission; however, you must fill 
   out the form, save it under a different name, and then send as 
   an email attachment to froi@iic.idaho.gov. 
 
 • One copy to the employer’s workers’ compensation insurer or 
   adjuster. 
 
 • One copy retained for the employer’s files. 
 
 4)  The Idaho Industrial Commission will be happy to answer your questions or 
 provide you with helpful brochures on Facts for Injured Workers and Guides 
 for Employers.  To obtain this service, please contact the Idaho Industrial 
 Commission at (208) 334-6000; or you may access many of these brochures 
 on these web pages.