Workers Compensation Forms and Templates

This form is used for verifying workers' compensation payments in the state of Texas. It helps to ensure that injured workers are receiving the correct amount of compensation.

This Form is used for notifying employees in Vermont about employer's liability and workers' compensation. It is available in French.

This form is used for transferring the attending provider for self-insured workers in Washington.

This document is used for measuring the accuracy of benefit claims related to nonseparation denial in Washington, D.C. It helps gather information from claimants to determine the validity of their claim.

This Form is used for obtaining a Certificate of Insurance in the state of West Virginia. It provides instructions on how to fill out Form AST FR-5 to request proof of insurance.

This form is used for filing a notice of injury and claim in the state of Wisconsin. It is used to report an injury that occurred on the job and to initiate the process of seeking workers' compensation benefits.

This document provides a summary report and wage listing for workers' compensation in Wyoming. It contains important information for employers and workers regarding compensation for work-related injuries.

This document is a report of injury form specific to the state of Wyoming. It is used to report any workplace injuries that occur in Wyoming. The form collects information about the injured person, the date and location of the incident, and details about the injury itself. Employers are required to fill out this form and submit it to the appropriate authorities.

This Form is used for contractors in Virginia to provide proof of workers' compensation insurance coverage.

This document is used to declare the worker's compensation policy for employees of the City of Petaluma, California. It outlines the coverage and benefits available in case of work-related injuries or illnesses.

This document provides an update on the current status of workers' compensation in Broome County, New York. It includes important information regarding workers' compensation laws, regulations, and benefits in the county.

This form is used for applying to resolve a claim related to occupational disease in the state of Kentucky.

This form is used for applying for Temporary Total Disability (TTD) benefits and requesting an expedited hearing in the state of Kentucky.

This form is used by employees in Kentucky to report the first instance of a work-related injury or illness. It ensures prompt and appropriate compensation for the workplace incidents under the State's Workers' Compensation Law.

This form is used for notifying workers in New York of their right to choose a healthcare provider authorized by the Workers' Compensation Board. The form is available in both English and Arabic.

This form is used for filing a claim for compensation in a death case in New York. It is available in Arabic.

This Form is used for authorizing a third party to act on behalf of a self-insured employer in Washington state.

This document is used to apply for workers compensation insurance in Trappe Borough, Pennsylvania.

This document is for converting workers' compensation disability payments to leave on a full-time employee's timesheets in Florida.

This Form is used for converting workers' compensation disability payments to leave on a part-time employee's timesheets in Florida.

This form is used for obtaining information about workers' compensation insurance coverage or exemption in Schwenksville Borough, Pennsylvania.

This document is used in Wake County, North Carolina to declare exemption from workers' compensation requirements.

This Form is used for filing a Certificate of Mailing for Worker's Compensation cases in Cook County, Illinois.

This document is for regulated businesses in San Francisco, California to declare their workers' compensation coverage.

This Form is used for reporting workers' compensation liability information in the state of Florida. It is required by the Florida Department of Business and Professional Regulation (DBPR).

This Form is used for authorizing workers' compensation and release of information in the state of Florida.

This form is used for settling workers' compensation claims in Colorado.

This form is used for requesting information in the state of Iowa.

This form is used for Kentucky workers to request the use of accumulated leave for workers' compensation purposes.

This Form is used for reporting incidents that occur in the workplace in the province of Manitoba, Canada.

This form is used for doctors in New York to report on the patient's Maximum Medical Improvement (MMI) and Permanent Partial Impairment (PPI).