Report an Injury

First 3 Days

When an employee injury occurs, you should file a Report of Injury (IA-1) within 3 days of your awareness to the incident. Even if you think the claim is not legitimate, file the Report of Injury anyway. The report is NOT committal - it is simply an alert to KESA that a claim needs to be investigated. Submitting the report does not bind you to paying a claim.

Report of Injury Form (IA-1)

Online

The fastest, easiest way to submit a Report of Injury is online.  If you already have a user name and password, click on the login button at the upper right corner.  If you do not have a user name and password, please contact kesasupport@kesa.org.  After logging in, click on the Report Injury button and you will be prompted through the form.

Email or Fax

You may email your form to firstreports@kesa.org or fax to 502-894-0066.

Call

You can call in your Report of Injury to 502-894-8484.

KYOSHA 803 KAR 2:180 Recordkeeping; Reporting Workplace Fatalities, Amputations, and Hospitalizations