Industrial Commission of Arizona Forms

This form is used by employers in Arizona to report any work-related injuries that occur on the job.

This Form is used for applying to become a special inspector in the state of Arizona.

This Form is used for renewing a special boiler inspector license in the state of Arizona.

This Form is used for applying for a variance in the state of Arizona.

This form is used for self-providers of medical benefits in Arizona. It is also known as the Accounting ICA6621 form.

This form is used for reporting workers' compensation liability in Arizona for accounting purposes.

This form is used for submitting workers' compensation documents to the relevant authorities in Arizona. It is specifically designed for individuals or organizations who are considered interested parties in a workers' compensation case.

This Form is used for self-insured companies in Arizona to notify termination of their self-insurance status.

This Form is used for ordering the Adosh Standards Book in Arizona. It is used to request a copy of the book that contains safety and health standards for the workplace.

This Form is used for reporting serious events in the state of Arizona to ADOSH (Arizona Division of Occupational Safety and Health).

This form is used for applying for a permit to install or make alterations to elevators, dumbwaiters, escalators, and other similar equipment in Arizona. It is required under the Arizona Elevator Act - a.r.s Title 23, Chapter 2, Article 12.

This form is used for requesting inspection of a non-weld alteration or repair of a boiler or fired pressure vessel in Arizona.

This form is used for requesting training through the Arizona Division of Occupational Safety and Health (ADOSH).

This form is used for requesting a hearing in the state of Arizona.

This Form is used for requesting permission to leave the state of Arizona. It is necessary for individuals who need to travel outside of Arizona and require authorization from the appropriate authorities.

This form is used for requesting a change in doctors in Arizona. It is used to submit a formal request to switch primary care physicians or specialists.

This Form is used for workers in Arizona to report an injury that occurred while on the job.

This type of document is used to notify individuals in Arizona about a pending suspension of their claims.

This document is used for providing notice of a professional employer agreement in Arizona.

This Form is used for employers in Arizona to report industrial injuries suffered by their employees.

This Form is used for employees in Arizona to notify their employer of their rejection of the terms of the Arizona Workers' Compensation Law.

This form is used for reporting significant work exposure to bodily fluids or other infectious material in the state of Arizona. It helps employers and employees to document and address potential health risks in the workplace.

This Form is used for filing a petition in Arizona to rearrange or readjust compensation.

This form is used for an employee to revoke their rejection of the terms of the Arizona Workers' Compensation Law in Arizona.

This form is used for filing a petition to reopen a case in Arizona based on new, additional, or previously undiscovered disability or condition.

This form is used for filing a complaint against an employer in Arizona who does not have workers' compensation insurance.

This form is used for businesses in Arizona to apply for authority to self-insure their accounting matters.

This Form is used for filing a public complaint regarding labor issues in Arizona.

This form is used for Arizona workers to report their annual income. It is used for claiming worker's compensation benefits.

This Form is used for companies in Arizona to apply for authority to self-insure their workers' compensation liabilities under Arizona Revised Statutes 23-961.01.

This form is used for claiming dependent's benefits in the event of a fatality in Arizona.

This form is used for medical treatment preauthorization in Arizona.

This Form is used for notifying the carrier about a scheduled injury in the state of Arizona.

This document is used by carriers to be notified of a scheduled injury in Arizona.

This type of document is used to inform the carrier about a scheduled injury in Arizona.

This form is used for reporting earned paid sick time in Arizona.

This form is used for employers to respond to inquiries regarding workers' compensation insurance in Arizona.

This document is used for filing a supplemental claim for compensation for workers in the state of Arizona. It allows workers to request additional compensation for work-related injuries or illnesses.