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Publications and Forms

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.

Physicians Report on Eye Injuries (WC-241)

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

Quarterly Wage Report Continuation Sheet (MODES-10B)

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.

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-Evaluation Questionnaire / Work Search Record (MODES-4633)

A self-evaluation questionnaire to be completed by an unemployed claimant.

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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