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Publications and Forms

Voluntary Payment Information and Work Sheet (MODES-2272)

Work sheet and information for employers who wish to make voluntary payments to reduce their contribution rates.

Workers' Compensation Subpoena (WC-25-AI)

A subpoena for a workers compensation case requiring the attendance of an individual at a hearing.

Workers' Compensation Subpoena Duces Tecum (WC-25-A-AI)

A subpoena for a workers compensation case requiring the attendance of an individual—along with specified documents or other evidence—at a hearing.

Workers' Compensation Subpoena Duces Tecum For Deposition (WC-25-C-AI)

A subpoena for a workers compensation case requiring the attendance of an individual—along with specified documents or other evidence—at a deposition.

Workers' Compensation Subpoena For Deposition (WC-25-B-AI)

A subpoena for a workers compensation case requiring the attendance of an individual at a deposition.

2011 Workforce Diversity Plan

The plans and policies of the Department of Labor and Industrial Relations regarding equal employment opportunity to applicants without regard to race, color, religion, sex, age, national origin, political belief, veteran status, and physical or mental disability.

Affidavit for Security Release (WC-264)

A sample affidavit for former self-insured employers requesting release of security.

Affidavit for Security Release - Group Trusts (WC-264-G)

A sample affidavit for former self-insured group trusts requesting release of security.

Affidavit of Exemption for Workers' Compensation Insurance (WC-134)

An affidavit that construction industry business owners who are not required to purchase workers’ compensation insurance may use to aid them in obtaining business licenses from some cities and counties.  Note: This form should not be sent to the Division of Workers’ Compensation.

Application for Authority to Self-Insure (WC-81)

The application to be completed by an employer applying to individually self-insure.

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