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KANSAS DEPARTMENT OF LABOR www. dol.ks. gov ACCIDENT REPORT K-WC 1101-A Rev. 1-12 SEE INSTRUCTIONS ON PAGE 2 There is a 250 penalty for repeated failure to file accident reports within 28 days of the date the employer is informed of the accident. Submission does not constitute admission of liability. Page 1 of 2 Mail or fax ORIGINAL report to Division of Workers Compensation 401 SW Topeka Blvd. Suite 2 Topeka KS 66603-3105 Fax 785 296-4216 Direct questions or comments to Toll-free 800...
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