Forms and other worker's compensation information

Reporting the injury, illness, or exposure

Employees

Injury report Employee's work injury and illness report

English | Spanish/Español
Hmong/Hmoob | Tibetan

Supervisors

Injury report Employer's first report of injury or disease

English only

Supervisors

Accident analysis
Supervisor's Accident Analysis and
Evaluation of Repetitive Motion and/or
Material Handling Activities

English only

 

Other forms

Voluntary and Informed Consent for Disclosure of Health Care Information – Employee

Safety Coordinator's Review – Safety coordinator, safety committee, or other designated individual or group

Part Time Labor Market Availability Statement

Medical Records Authorization

Forms for Worker's Compensation Coordinators

  1. STARS Web Access Request and User Agreement
  2. STARS Workstation Requirements

 

Page last saved: 06/02/2014