File a Claim

How to Report an On-the-Job Injury

1. Medical Treatment:
   Immediately refer injured worker to closest directed care medical clinic. (Click for a list of providers: Utah or Arizona) If the injury is life or limb threatening, call 911 and go immediately to the closest emergency facility.
   
   
2. Report Work-Related Injury:
   Choose from four ways to report injury:
   
   Utah Claims:
   • Internet:Use our secure, online version of the First Report of Injury (Form 122).
     Utah Claim Form
   • Fax:Fax Form 122 to TRISTAR Risk Management at (801) 568-5164
   • Phone:Call TRISTAR Risk Management at (888) 364-8943 or (801) 568-5138
   • Mail:
     
     TRISTAR Risk Management
     45 West 1000 South, Suite 307
     Sandy, UT 84070-3660
   
   
   

Arizona Claims:
• Internet: Use our secure, online version of the First Report of Injury (Form 101).
  Arizona Claim Form
• Fax: Fax Form 101 to TRISTAR Risk Management at (800) 599-2990 or (602) 997-6804
• Phone: Call TRISTAR Risk Management at (800) 201-0727 or (602) 331-3511
• Mail:
  
  TRISTAR Risk Management
  1819 East Morten Ave, Suite 220
  Phoenix, AZ 85020-4662



3. Contact your claims adjuster at TRISTAR Risk Management to discuss any questionable claims.
   
   
4. Document the circumstances surrounding the injury.
   • Conduct a thorough investigation.
   • Look at the accident site.
   • Determine why it happened.
   • Secure evidence/take photos.
   • Interview witnesses and obtain names.