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Alaska Workers' Compensation Form

Product Specifications:

  • This form is 8.5" x 11"
  • 25 Sheets/Package


* Required Fields


Alaska Workers Compensation Form

According to the Alaska Workers' Compensation Act, employers are required to pay employees for their medical costs and part of their lost wages if they are injured or become ill on the job, including disability payments. Additionally, employers must pay benefits to dependants of employees if the employee is injured in a work-related death.

Description of Alaska Workers Compensation Requirements

Whenever an employee in Alaska has been injured or becomes ill in the workplace, the employee may be entitled to receive workers compensation benefits as a result of the injury or illness. The Alaska Workers Compensation program states that employers responsible for providing injured or ill employees with medical benefits, disability benefits, and re-employment benefits in the event that the employees are injured or become ill while on the job as a result of the work performed for the employer.

When an employee is killed while on the job, the Alaska Workers Compensation program requires employers to provide the employee's dependants with death benefits.

Employees should be compensated based on their total earnings at the time of the injury of illness. All employees may receive compensation for their illness or injury, including full-time, part-time, hourly, temporary, and seasonal employees.

Employee Reporting Responsibility

In order for employees to receive workers compensation, the employee needs to report the injury or illness to the employer. The employee should provide the employer with written notice of the injury of illness within 30 days of the incident. Employers should provide employees with the proper notification form when the form is requested by the employee.

Employees are required to complete a portion of the form on their own, including information about the incident that caused them injury or illness, witnesses, their supervisor's name, and conditions that may have resulted in the injury or illness. The employee should also provide contact information for his or her doctor that treated the injury or illness.

Employer Reporting Responsibility

Employers should provide employees with the required reporting form. Once employees complete their portion of the reporting form, employers should complete their portion and mail the reporting form to the Alaska Division of Workers' Compensation.

Description of Alaska Workers Compensation Form

This Alaska Workers Compensation Forms are designed using federal reporting standards and is compliant with all state and federal labor laws regarding workers compensation reporting requirements. The Alaska Workers Compensation Forms are easy to read and contains clearly marked fields for all required data and information.

These forms contain separate sections to be filled out by employees and by employers. The forms also contain a disclosure statement that employees must sign for verification of their claim of injury or illness. Forms come in a pack of 25.

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