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)


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  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 or fax to 502-894-0066.


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

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