Korean work injury form: A Korean work injury form becomes usable when urgent care comes first and the worker, workplace, accident chronology, medical opinion and consent sections are completed from records.
Korean work injury form: This guide explains the initial industrial-accident medical care benefits application and attached opinion form. It does not diagnose an injury or guarantee recognition or payment.
Korean work injury form: What you will finish
You will record identity and work details, write the accident circumstances, identify reports and witnesses, attach the medical opinion, read consent choices and keep proof.
Read the fields, preview the form, download the official original, then open the source page
The current four-page KCOMWEL PDF contains the industrial-accident medical care benefits application and medical opinion. Bold-line fields are mandatory. It asks for the worker, workplace, accident circumstances, earlier treatment, filing authorization, other compensation and consent; the clinician completes the opinion section.
How to complete the medical care benefits application
- Worker and work details: foreign residents copy the uppercase English name and registration number from the card, then enter address, contact, hire date, work times, occupation, worker type and claim category.
- Workplace and accident narrative: enter the workplace identifiers, then explain where, what task, what tool or substance, what movement and why the injury occurred. Use an extra sheet if necessary.
- Reports, witnesses and treatment: mark police, 119 or insurer reports only when true, add witness contact details, and list institutions that treated you before the current one.
- Authorization, attachments, compensation and consent: sign only if authorizing medical-institution filing, attach the official medical opinion, disclose relevant prior compensation, distinguish required from optional consent, and keep the full signed copy.
Worked example: a worker copies the registration-card name, shift and workplace details; writes that a hand was injured while operating a named tool at a recorded time and place; adds a witness and first clinic; asks the clinician to complete the opinion; reads consent; signs; and saves the receipt. The narrative must match the available records.
- Official form preview
- Official original download
Official medical care benefits application and medical opinion PDF · 4 pages · 522,978 bytes
- Official source page
Verified 25 August 2026: KCOMWEL’s four-page PDF revised 7 July 2026 was 522,978 bytes and its PDF signature and SHA-256 matched. The public file is linked directly and not mirrored.
Eight steps from facts to a filed official form
- 1. Confirm the correct procedure
- 2. Prepare identity and contact details
- 3. Write the event in date order
- 4. Collect supporting records
- 5. Read every official form field
- 6. Draft facts before copying
- 7. Review attachments and consent
- 8. Submit and save proof
24 Korean phrases for the form and submission
Use the learner-friendly pronunciation first and RR only as a reference. Confirm difficult sounds with Korean audio or a speaker.
1. Confirm the correct procedure
Start at the official source and confirm that this form fits your case.
| # | Korean | How to say it | Natural meaning |
|---|---|---|---|
| 1 | 산재 요양급여 신청서를 작성하고 싶습니다. | sahn-jeh yoh-yahng-geu-byuh seen-chuhng-suh-reul jahk-ssuhng-hah-goh seep-sseum-nee-dah. RR: Sanjae yoyanggeubyeo sincheongseoreul jaksseonghago sipsseumnida. |
I want to complete the industrial-accident medical benefits application. |
| 2 | 업무 중 다쳤습니다. | uhm-moo joong dah-chyuht-sseum-nee-dah. RR: Eommu jung dachyeotsseumnida. |
I was injured while working. |
| 3 | 먼저 진료를 받겠습니다. | muhn-juh jeen-ryoh-reul baht-kkeht-sseum-nee-dah. RR: Meonjeo jinryoreul batkketsseumnida. |
I will receive medical care first. |
2. Prepare identity and contact details
Copy names, numbers and addresses from current documents instead of memory.
| # | Korean | How to say it | Natural meaning |
|---|---|---|---|
| 4 | 외국인등록증의 영문명을 적겠습니다. | weh-goo-geen-deung-rohk-jjeung-ui yuhng-moon-myuhng-eul juhk-kkeht-sseum-nee-dah. RR: Oegugindeungrokjjeungui yeongmunmyeongeul jeokkketsseumnida. |
I will write the English name on my foreign registration card. |
| 5 | 재해 발생 일시는 언제인가요? | jeh-heh bahl-sehng eel-see-neun uhn-jeh-een-gah-yoh? RR: Jaehae balsaeng ilsineun eonjeingayo? |
When did the accident occur? |
| 6 | 출근시간과 퇴근시간을 확인해 주세요. | chool-geun-see-gahn-gwah tweh-geun-see-gah-neul hwah-geen-heh joo-seh-yoh. RR: Chulgeunsigangwa toegeunsiganeul hwaginhae juseyo. |
Please check my start and finish times. |
3. Write the event in date order
Use dates, places, people and actions; separate facts from guesses.
| # | Korean | How to say it | Natural meaning |
|---|---|---|---|
| 7 | 제 직종은 무엇으로 적나요? | jeh jeek-jjohng-eun moo-uh-seu-roh juhng-nah-yoh? RR: Je jikjjongeun mueoseuro jeongnayo? |
What should I enter as my occupation? |
| 8 | 업무상 사고에 표시하겠습니다. | uhm-moo-sahng sah-goh-eh pyoh-see-hah-geht-sseum-nee-dah. RR: Eommusang sagoe pyosihagetsseumnida. |
I will mark occupational accident. |
| 9 | 사업장관리번호를 알려 주세요. | sah-uhp-jjahng-gwahn-ree-buhn-hoh-reul ahl-ryuh joo-seh-yoh. RR: Saeopjjanggwanribeonhoreul alryeo juseyo. |
Please tell me the workplace management number. |
4. Collect supporting records
Keep originals and submit copies unless the receiving office asks otherwise.
| # | Korean | How to say it | Natural meaning |
|---|---|---|---|
| 10 | 사업장명과 주소를 확인해 주세요. | sah-uhp-jjahng-myuhng-gwah joo-soh-reul hwah-geen-heh joo-seh-yoh. RR: Saeopjjangmyeonggwa jusoreul hwaginhae juseyo. |
Please check the workplace name and address. |
| 11 | 재해 경위를 시간순으로 적겠습니다. | jeh-heh gyuhng-wee-reul see-gahn-soo-neu-roh juhk-kkeht-sseum-nee-dah. RR: Jaehae gyeongwireul sigansuneuro jeokkketsseumnida. |
I will write the accident chronology. |
| 12 | 어디에서 다쳤는지 구체적으로 쓰겠습니다. | uh-dee-eh-suh dah-chyuhn-neun-jee goo-cheh-juh-geu-roh sseu-geht-sseum-nee-dah. RR: Eodieseo dachyeonneunji guchejeogeuro sseugetsseumnida. |
I will state exactly where I was injured. |
5. Read every official form field
Mark required fields, conditional sections, signatures and representative details.
| # | Korean | How to say it | Natural meaning |
|---|---|---|---|
| 13 | 무슨 작업을 하고 있었는지 적겠습니다. | moo-seun jah-guh-beul hah-goh ee-ssuhn-neun-jee juhk-kkeht-sseum-nee-dah. RR: Museun jageobeul hago isseonneunji jeokkketsseumnida. |
I will write what task I was doing. |
| 14 | 사용한 도구와 움직임을 적겠습니다. | sah-yohng-hahn doh-goo-wah oom-jee-gee-meul juhk-kkeht-sseum-nee-dah. RR: Sayonghan doguwa umjigimeul jeokkketsseumnida. |
I will write the tool and movement involved. |
| 15 | 목격자의 연락처가 있습니다. | mohk-kkyuhk-jjah-ui yuhn-rahk-chuh-gah eet-sseum-nee-dah. RR: Mokkkyeokjjaui yeonrakcheoga itsseumnida. |
I have the witness’s contact details. |
6. Draft facts before copying
Draft a short chronology, then copy it consistently into the form.
| # | Korean | How to say it | Natural meaning |
|---|---|---|---|
| 16 | 119에 신고한 사실이 있습니다. | 119eh seen-goh-hahn sah-see-ree eet-sseum-nee-dah. RR: 119e singohan sasiri itsseumnida. |
The event was reported to 119. |
| 17 | 먼저 진료받은 의료기관을 적겠습니다. | muhn-juh jeen-ryoh-bah-deun ui-ryoh-gee-gwah-neul juhk-kkeht-sseum-nee-dah. RR: Meonjeo jinryobadeun uiryogigwaneul jeokkketsseumnida. |
I will list the first medical institution. |
| 18 | 의료기관 대행 제출에 동의할 수 있나요? | ui-ryoh-gee-gwahn deh-hehng jeh-choo-reh dohng-ui-hahl soo een-nah-yoh? RR: Uiryogigwan daehaeng jechure donguihal su innayo? |
Can I consent to filing by the medical institution? |
7. Review attachments and consent
Check evidence names, page order, personal data and any consent statement.
| # | Korean | How to say it | Natural meaning |
|---|---|---|---|
| 19 | 요양급여신청 소견서를 첨부해야 하나요? | yoh-yahng-geu-byuh-seen-chuhng soh-gyuhn-suh-reul chuhm-boo-heh-yah hah-nah-yoh? RR: Yoyanggeubyeosincheong sogyeonseoreul cheombuhaeya hanayo? |
Must I attach the medical opinion? |
| 20 | 다른 보상금을 받은 적이 없습니다. | dah-reun boh-sahng-geu-meul bah-deun juh-gee uhp-sseum-nee-dah. RR: Dareun bosanggeumeul badeun jeogi eopsseumnida. |
I have not received other compensation. |
| 21 | 개인정보 동의 항목을 읽어 보겠습니다. | geh-een-juhng-boh dohng-ui hahng-moh-geul eel-guh boh-geht-sseum-nee-dah. RR: Gaeinjeongbo dongui hangmogeul ilgeo bogetsseumnida. |
I will read the personal-data consent. |
8. Submit and save proof
Use an accepted channel, keep a complete copy and record the receipt number.
| # | Korean | How to say it | Natural meaning |
|---|---|---|---|
| 22 | 선택 동의와 필수 동의를 구분해 주세요. | suhn-tehk dohng-ui-wah peel-soo dohng-ui-reul goo-boon-heh joo-seh-yoh. RR: Seontaek donguiwa pilsu donguireul gubunhae juseyo. |
Please distinguish optional and required consent. |
| 23 | 서명한 신청서 사본을 보관하겠습니다. | suh-myuhng-hahn seen-chuhng-suh sah-boh-neul boh-gwahn-hah-geht-sseum-nee-dah. RR: Seomyeonghan sincheongseo saboneul bogwanhagetsseumnida. |
I will keep a copy of the signed application. |
| 24 | 접수 후 진행 상황을 확인하겠습니다. | juhp-ssoo hoo jeen-hehng sahng-hwahng-eul hwah-geen-hah-geht-sseum-nee-dah. RR: Jeopssu hu jinhaeng sanghwangeul hwaginhagetsseumnida. |
I will check progress after filing. |
20 words to recognize
| # | Korean | Pronunciation | Meaning |
|---|---|---|---|
| 1 | 산업재해 | sah-nuhp-jjeh-heh RR: Saneopjjaehae |
industrial accident |
| 2 | 요양급여 | yoh-yahng-geu-byuh RR: Yoyanggeubyeo |
medical care benefits |
| 3 | 신청서 | seen-chuhng-suh RR: Sincheongseo |
application |
| 4 | 재해자 | jeh-heh-jah RR: Jaehaeja |
injured worker |
| 5 | 외국인등록번호 | weh-goo-geen-deung-rohk-ppuhn-hoh RR: Oegugindeungrokppeonho |
foreign registration number |
| 6 | 채용일자 | cheh-yohng-eel-jah RR: Chaeyongilja |
hire date |
| 7 | 직종 | jeek-jjohng RR: Jikjjong |
occupation |
| 8 | 업무상 사고 | uhm-moo-sahng sah-goh RR: Eommusang sago |
occupational accident |
| 9 | 사업장관리번호 | sah-uhp-jjahng-gwahn-ree-buhn-hoh RR: Saeopjjanggwanribeonho |
workplace management number |
| 10 | 사업장명 | sah-uhp-jjahng-myuhng RR: Saeopjjangmyeong |
workplace name |
| 11 | 재해 발생 경위 | jeh-heh bahl-sehng gyuhng-wee RR: Jaehae balsaeng gyeongwi |
accident circumstances |
| 12 | 작업내용 | jah-guhm-neh-yohng RR: Jageomnaeyong |
work task |
| 13 | 작업도구 | jah-guhp-ttoh-goo RR: Jageopttogu |
work tool |
| 14 | 목격자 | mohk-kkyuhk-jjah RR: Mokkkyeokjja |
witness |
| 15 | 119 신고 | 119 seen-goh RR: 119 singo |
119 report |
| 16 | 의료기관 | ui-ryoh-gee-gwahn RR: Uiryogigwan |
medical institution |
| 17 | 대행 제출 | deh-hehng jeh-chool RR: Daehaeng jechul |
filing authorization |
| 18 | 소견서 | soh-gyuhn-suh RR: Sogyeonseo |
medical opinion |
| 19 | 개인정보 동의 | geh-een-juhng-boh dohng-ui RR: Gaeinjeongbo dongui |
privacy consent |
| 20 | 진행 상황 | jeen-hehng sahng-hwahng RR: Jinhaeng sanghwang |
progress status |
Replies you may hear
- 외국인은 등록증상 영문명을 대문자로 적어 주세요. – Foreign residents should write the uppercase English name on their registration card.
- 굵은 선 안은 필수 기재사항입니다. – Fields inside the bold line are required.
- 재해 경위를 사실대로 구체적으로 적어 주세요. – Write the accident circumstances truthfully and specifically.
- 사고 장소와 작업내용, 도구와 동작을 적어 주세요. – State the place, task, tool and movement.
- 목격자와 신고 사실이 있으면 표시해 주세요. – Mark witnesses and reports if they exist.
- 요양급여신청 소견서를 첨부해 주세요. – Attach the medical opinion for the application.
- 필수 동의와 선택 동의를 구분해 주세요. – Distinguish required consent from optional consent.
- 접수 후 토탈서비스에서 진행 상황을 확인할 수 있습니다. – You can check progress through Total Service after filing.
Two form-preparation dialogues
1
근로자: 업무 중 다쳐서 요양급여를 신청하고 싶습니다.
담당자: 먼저 치료를 받고 사고 일시와 작업 내용을 정리하세요.
근로자: 장소, 도구, 움직임을 시간순으로 적었습니다.
담당자: 목격자와 신고 내역도 사실대로 표시하세요.
근로자: 소견서와 함께 제출하겠습니다.
The worker receives treatment, drafts the exact accident chronology and prepares the medical opinion.
2
근로자: 의료기관이 신청서를 대신 제출할 수 있나요?
원무담당: 위임 동의란과 서명을 먼저 확인해야 합니다.
근로자: 필수 동의와 선택 동의를 나누어 읽었습니다.
원무담당: 제출 전 신청서와 소견서 사본을 보관하세요.
근로자: 접수번호로 진행 상황을 확인하겠습니다.
The worker reads authorization and consent, keeps copies and saves the receipt.
Final form checklist
- Confirm form and deadline
- Use current official file
- Prepare ID and contact
- Write a dated chronology
- Use exact names and numbers
- Separate facts from opinion
- List every attachment
- Check signature and consent
- Keep a full copy
- Save submission proof
Scope and filing boundaries
- The form does not guarantee approval
- Do not invent missing facts
- Do not alter an official file
- Protect unrelated personal data
- Use an interpreter when accuracy is at risk
- Confirm urgent deadlines with the receiving office
Get emergency medical help first for severe injury. Do not delay treatment to finish a form. Write facts, not a diagnosis or legal conclusion, and ask KCOMWEL or the treating institution when a field is unclear.
Prepared by BSKorean Content Studio. KCOMWEL’s form revised 7 July 2026 and official guidance were checked on 25 August 2026.
Official sources checked
- KCOMWEL — current 7 July 2026 application and opinion form
- KCOMWEL — official four-page PDF
- KCOMWEL — official application guidance
Five-minute practice
Open the official form beside this guide. Draft the facts in date order, copy them into the matching fields, check the attachments and signature, then save proof of submission.