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Publications and Forms

Memorandum to Commercial Insurers (WC-240-3)

A memo regarding the affidavit of zero reporting for commercial insurers.

Physicians Report on Eye Injuries (WC-241)

A form to be completed by physician examining a workers compensation eye injury.

Religious Exception Application and Affidavit Instructions (WC-138-7)

Instructions for completing the application, affidavit and waiver of workers compensation benefits.

Religious Exception Information (WC-138-A)

Information regarding employees who wish to be exempt from workers' compensation law because of religious reasons.

Report Your Workplace Injury/Occupational Disease or Repetitive Trauma Injury (WC-280)

This form allows employees to provide proper written notification to their employer when a workplace injury/occupational disease occurs.

Self-Insurance By-Laws - Sample (WC-238)

A sample of by-laws that may be used as a reference when forming a new group trust.

Self-Insured Trust Safety Program Initial Certification Procedures (WC-129-AI)

Certification procedures for a self-insured group trust’s safety program.

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