Claims Forms for Employers

Claims Forms for Employers

Read each form carefully to ensure you accurately complete it.

Contact us at 1-800-661-0792 if you need assistance, or for more information.

NEW: EMPLOYER’S REPORT OF INCIDENT FORM

Employers must submit the fully-completed incident report within three business days, or will incur penalties as listed in the Workers’ Compensation Acts. Please note that to report an accident causing serious bodily injury or a dangerous occurrence, you must call the 24-hour Incident Reporting line at 1-800-661-0792 as soon as is reasonably possible and complete and submit this form within three business days.

 

Forms

Employer's Report of Incident
Employer's Report of Fatal Injury
Electronic Fund Transfer
Employer's Continuity Report
Employer's Repetitive Strain Questionnaire