The checklist of required items and information that must accompany the Application for Self-Insurance Trust (WC-81A).

A guaranty of a third party to satisfy an individually self-insured employer’s workers’ compensation obligations under Missouri law.

Information for Appeals Tribunal hearings, including what they are, instructions, and other important facts to know.

This form allows attorneys that are parties to a case to jointly submit a motion for change of venue.  All parties must agree to the change of venue. 

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

The Division uses the Quarterly Wage Report Continuation Sheet to allow reporting of additional employees when there are more employees than will fit on the Quarterly Contribution and Wage Report (MODES-4). This form MODES-10B should be attached to the MODES-4.

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

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

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