Claim form DWC-1 asks for your name and address and the date, time, and location of your injury, as well as a description of the injury. Instructions for filling out the claim form can be found on the form itself. Be sure to name each body part that has been injured. You submit this form to your employer (by handing it to the employer or sending it by certified mail), and the employer is required to submit it to its workers’ compensation insurance company.