Date of first full day employee lost from work C-11/EC-11 11. Nature of Injury 12. Date employee returned to work 13. STATE OF NEW YORK WORKERS COMPENSATION BOARD EMPLOYER S REPORT OF INJURED EMPLOYEE S CHANGE IN EMPLOYMENT STATUS RESULTING FROM INJURY This report is to be filed directly with the Chair Workers Compensation Board at the address shown on reverse side as soon as the employment status of an injured employee as reported on First Report of Injury or on a previous Form C-11 or EC-11...
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