Forms and other worker's compensation information

Reporting the injury, illness, or exposure


Injury report Employee's work injury and illness report

English | Spanish/Español
Hmong/Hmoob | Tibetan


Injury report Employer's first report of injury or disease

English only


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

Forms for Worker's Compensation Coordinators

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


Page last saved: 10/17/2013