Claims Forms & Documents

Common forms for injured workers and claims processes


First Report of Injury Forms

Click here to complete & submit the form online.
Alabama: Employer's First Report of Injury
Arkansas: First Report of Injury or Illness
Connecticut: Employers First Report of Occupational Injury or Illness
Florida: First Report of Injury or Illness
Georgia: First Report of Injury or Occupational Disease
Louisiana: First Report of Injury or Illness
Mississippi: First Report of Injury or Illness
Missouri: Report of Injury
New Jersey: First Report of Injury or Illness
North Carolina: Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission
Oklahoma: First Notice of Claim For Compensation
Pennsylvania: First Report of Injury
Tennessee: Employer's First Report of Injury or Illness
Texas: First Report of Injury or Illness
Virginia: First Report of Injury

Mileage Reimbursement Request

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