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Publications and Forms

Request for Pre-Hearing (WC-183)

Request to DWC for a pre-hearing regarding workers compensation claim.

Request for Wage Determination (PW-3)

A form to request a wage determination according to Chapter 290 RSMo.

Resource Guide for Employers (MODOL-4466)

A resource guide for employers containing information about unemployment insurance, workers' compensation, wage and hour standards, discrimination, FMLA, child labor laws, mine and cave safety, and federal requirements.

Salario Mínimo de Missouri requiere del cartel (LS-52-S)

Cartel para colgar en el lugar de trabajo a Missouri salario mínimo.

Shared Work Plan Application (MODES-SW-1)

Apply for the Shared Work Program, an alternative to laying off your employees!

Shared Work: An Alternative to Laying Off (MODES-4786)

Information regarding the Shared Work Program relating to employers and employees.

Showing of Interest Signature Form (SBM-09)

A list to be completed by employees naming their exclusive bargaining representative.

Showing of Interest Signature Form - Decertification Petition Only (SBM-10)

A list to be completed by employees decertifying their exclusive bargaining representative.

Statement of Specific and Aggregate Excess Insurance Coverage (WC-121)

Proof of initial, renewal, or changes to specific and aggregate Missouri only excess insurance coverage.

Survivors' Benefits: For Family Members of Missouri's Fallen Workforce (WCLoD-15)

A brochure outlining the benefits provided by the Missouri Workers’ Compensation Law in the event of a compensable fatal accident or fatal occupational disease.

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