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Publications and Forms

Employer's Affidavit for Religious Exception (WC-138-5)

The affidavit to be completed by an employer when requesting for an employee to be exempt from workers' compensation due to religious reasons.

Escrow Agreement (WC-82E)

An Escrow Agreement; one of three options available to meet the self-insurance security requirement.

Group Insurance Checklist (WC-239)

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

Guaranty to Satisfy Compensation Claims Under Workers’ Compensation Law of Missouri (WC-82A)

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 (MODES-INF-166)

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

Joint Motion for Change of Venue (WC-281)

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. 

Memorandum to Commercial Insurers (WC-240-3)

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

Mo Child Labor Law for School Officials (LS-26)

A guide to the child labor law for school officials.

Payroll Records Required By Law (MODES-31)

A poster containing information about payroll records to be displayed in workplace.

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