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State Workers' Compensation Forms

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  1. Alabama First Report of Injury Form

    Alabama First Report of Injury Form

    $14.95

    In Alabama, it's the law for employers to report any instance of employee injury in the workplace. Prompt and complete reporting is not only essential for maintaining a safe workplace --it's also mandatory in order to protect yourself from regulation violations and other penalties for failing to report.

    The Alabama First Report of Injury Form is exactly what you need to provide an initial employee injury report. In a single 8.5 x 11 page, all of the key information you need to capture is easily and clearly organized for you. This ensures that your form is complete, and that you are following mandatory regulations – and protecting the success and stability of your business.

    Plus, each package of Alabama First Report of Injury Forms contains 25 forms, so you don't have to worry about running out.

    Product Specifications:

    • 25 forms / package, 8.5 x 11
    Learn More
  2. Arizona Employers Report of Industrial Injury

    Arizona Employers Report of Industrial Injury

    $14.95

    Arizona employers are required to report an industrial injury or illness within 10 days of an accident resulting in injury or illness and within 24 hours of an accident resulting in a fatality.

    Whenever an employee is injured in the workplace in Arizona, the employer must complete the Employer’s Report of Industrial Injury in order to be compliant with OSHA reporting requirements. The Employer’s Report of Industrial Injury must be completed and mailed within 10 days from the employee’s notice of an incident that resulted in injury or illness. The report must be completed and mailed within 24 hours in the event of a fatality.

    The form provides Arizona employers with fields in which they are required to describe the nature of the injury, illness, or fatality, circumstances surrounding the incident, and details about the employee’s condition. Employers are also required to provide information about the employee’s wages, expected date of return to work (if applicable), and loss of work.

    Arizona employers are required to retain a copy of all submitted Employer’s Report of Industrial Injury forms for at least five years after an incident has occurred.

    This package of Employer’s Report of Industrial Injury forms contains 25 forms that are fully compliant with federal OSHA reporting requirements and contain all of the necessary reporting fields that employers must complete in order to adequately report a workplace incident.

    Product Specifications:

    • This form is 8.5" x 11"
    • 25 Sheets/Package
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  3. Arizona First Report of Injury Form

    Arizona First Report of Injury Form

    $14.95

    Promptly and thoroughly reporting any instance of workplace injury to the Industrial Commission of Arizona is the law, and your failure to report can lead to serious penalties now and down the road. Protect your workers, protect yourself, and protect your business with our convenient Arizona First Report of Injury Forms.

    Each 8.5 x 11 form covers all of the information that you need to promptly provide the Commission. And since each package comes with 25 forms, you won't have to worry about running out – when supplies get low, simply order more.

    Product Specifications:

    • 25 forms / package, 8.5 x 11
    Learn More
  4. Arizona Rejection of Workers Compensation Form

    Arizona Rejection of Workers Compensation Form

    $14.95

    The Arizona Rejection of Workers' Compensation Form should be signed by all employees who reject the terms of the Arizona Workers’ Compensation Law. Employees must provide their addresses, social security numbers, policy numbers, and relationship to the employer along with their signatures. Employees must complete this form in order to lawfully reject the law.

    Employers must file the Employee’s Notice of Rejection of Terms of the Arizona Workers’ Compensation Law form with the SCF Arizona within five days of receipt of the notice from the employee. The employer may also wish to retain a copy of the notice for his or her own records.

    This package contains 25 Employee’s Notice of Rejection of Terms of the Arizona Workers’ Compensation Law notices that are fully compliant with all Arizona state laws. Employers should make these forms available to their employees in the event that the employees wish to reject the terms of the Arizona Workers’ Compensation law.

    Product Specifications:

    • This form is 8.5" x 11"
    • 25 Sheets/Package
    Learn More
  5. Page 1 (Front)

    Arkansas First Report of Injury Form

    $14.95

    Keeping your workplace safe for employees is not just good policy – in Arkansas, it's also the law. And part of your commitment to monitoring and managing any workplace injuries is to promptly complete a First Report of Injury Form and submit it to the Arkansas Workers' Compensation Commission.

    Our Arkansas First Report of Injury Form makes this task simple, quick and straightforward. In a single 8.5 x 11 page, you’ll find all of the information that needs to be completed and submitted. Because remember: promptly and completely submitting the form after any workplace injury is not just designed to keep your workplace safe – it's designed to keep your business safe, stable and successful.

    Each package of Arkansas First Report of Injury Forms contains 25 forms.

    Product Specifications:

    • 25 forms / package, 8.5 x 11
    Learn More
  6. California First Report of Injury Form

    California First Report of Injury Form

    $14.95

    California employers are required by law to complete a report of injury form upon receiving notification that an employee has been injured at work. The complete and dated form must then be given to an employee and insurer or claims administrator within one working day of the receipt of the form.

    The California First Report of Injury Form is exactly what you need to provide an initial employee injury report. In a single 8.5 x 11 page, all of the key information you need to capture is easily and clearly organized for you. This ensures that your form is complete, and that you are following mandatory regulations – and protecting the success and stability of your business.

    Plus, each package of California First Report of Injury Forms contains 25 forms, so you don't have to worry about running out.

    Product Specifications:

    • Each form is 8.5" x 11"
    • 25 Forms/Pkg
    Learn More
  7. California Time of Hire Workers' Compensation Pamphlet

    California Time of Hire Workers' Compensation Pamphlet

    $15.95

    California Time of Hire Workers' Compensation Pamphlet Update

    Effective July 1, 2014, the CA workers' compensation regulations will include new rules when pre-designating a physician or medical group for work-related injuries and illnesses. Part of this revision is the addition of two forms. The pamphlet is updated with the new regulations as well as the addition of the two new forms.

    About the California Time of Hire Workers' Compensation Pamphlet

    California law requires all employers to provide each new employee, either at the time of hire or by the end of their first pay period, the 'Written Notice to New Employees' concerning their rights, benefits and obligations under the CA workers' compensation law. The California Time of Hire Workers' Compensation Pamphlet is approved by the Division of Workers' Compensation to satisfy the employer's notification requirement.

    Each order includes 25 pamphlets with 25 forms for pre-designating a physician and 25 forms for pre-designating a chiropractor, acupuncturist or medical group.

    Product Specifications:

    • One packet includes 25 pamphlets, plus 25 each of the 2 forms
    • Each four-fold pamphlet is 2.8" x 8.5"
    • Each form is 8.5" x 11"
    • Available in English or Spanish
    Learn More
  8. Front

    Colorado First Report of Injury Form

    $14.95

    The Colorado Department of Labor and Employment requires that you promptly report any instance of employee injury. Your failure to do this can lead to serious regulatory and legal consequences down the road.

    You can safely avoid these consequences and help promote a safe, smart workplace with our Colorado First Report of Injury Forms. Each form is a single 8.5 x 11 page, and covers all of the information that the CDLE needs to promptly receive. And since each package comes with 25 forms, you won't have to worry about running out – when supplies get low, simply order more.

    Product Specifications:

    • 25 forms / package, 8.5 x 11
    Learn More
  9. Connecticut First Report of Injury Form

    Connecticut First Report of Injury Form

    $14.95

    As a Connecticut business, you're legally obligated to promptly inform the Connecticut Worker' Compensation Commission promptly after any employee injury. Regardless of how busy your workplace is, delaying this obligation can and will expose you to serious consequences, including legal and civil penalties.

    Protect yourself and fulfil your obligation by using our convenient Connecticut First Report of Injury Forms. Each 8.5 x 11 form covers all of the information you need to promptly provide to the Commission. Plus, each package of Connecticut First Report of Injury Forms contains 25 forms, so you don't have to worry about running out.

    Product Specifications:

    • 25 forms / package, 8.5 x 11
    Learn More
  10. Front

    Delaware First Report of Injury Form

    $14.95

    In Delaware, you're legally obligated to promptly report any instance of employee injury to the Delaware Office of Workers' Compensation. Doing so ensures that your business is compliant with the law, and that you're protecting yourself from any regulatory or legal penalties due to overlooking this critical task.

    Save time, effort and costs by using the Delaware First Report of Injury form. Each 8.5 x 11 form covers all of the information that the Delaware Office of Workers' Compensation expects to promptly receive after any and all workplace injury.

    Plus, each package of Delaware First Report of Injury forms contains 25 forms, so you don't have to worry about running out.

    Product Specifications:

    • 25 forms / package, 8.5 x 11
    Learn More

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