Claims Materials
Arizona Claims Materials
- Arizona Claims Kit Checklist
- Employers Report of Industrial Injury Form ICA-04-0101
- Information for employers for workers compensation Arizona
- Employer’s Report of Injury — Arizona
- Information for Injured Workers Arizona
- Medical Services Order Form – Arizona, Colorado, Utah
- Workers Report of Injury – Arizona
- AZ Minimum Wage Act Poster
- AZ Minimum Wage Act Poster – Spanish
- Employee Safety and Health Protection
- Notice to Employees
- Work Exposure to MRSA
- Work Exposure to Bodily Fluids
- Workers’ Compensation Temporary Prescription ID Card
- Out of State Claims Cover Sheet
California Claims Materials
- Claims Management
- Employee’s Claim for Workers’ Compensation Benefits DWC-1
- First Report of Injury Form 5020
- Medical Service Order form California
- MPN Distribution Acknowledgement
- MPN Handout English
- MPN Handout Spanish
- MPN Implementation Instructions
- MPN Poster English
- MPN Poster Spanish
- Notice to Employees Poster for Injuries Caused on the Job (DWC 7)
- WCAB Office Information Sheet
- Workers’ Compensation Temporary Prescription ID Card
- Time of Hire Pamphlet – English
- Time of Hire Pamphlet – Spanish
Colorado Claims Materials
- DOWC Insurance Requirements Brochure
- Employers Report of Injury – Colorado
- Information for Employers for Workers’ Compensation in CO
- Information for Employers for Workers’ Compensation in CO – Spanish
- Information for Injured Workers in Colorado
- Information for Injured Workers in Colorado – Spanish
- Medical Services Order Form – Arizona, Colorado, Utah
- Notice of Injury Poster
- Workers Compensation Information – Colorado
- Workers’ Compensation Poster
- Workers’ Compensation Poster (Spanish)
- Workers’ Compensation Temporary Prescription ID Card
Idaho Claims Materials
- Workers’ Compensation Notice Poster
- Workers’ Compensation Notice Poster – ESP
- Employers Report of Injury – Idaho
- A Guide for Employers of Injured Workers – Idaho
- Facts for Employers – Idaho
- Facts for Injured Workers – Idaho
- Medical Services Order Form – Idaho, Nevada, Oregon
- Idaho Claims Kit Checklist
- Employer’s Supplemental Report — Idaho
Nevada Claims Materials
- Employers Report of Injury – Nevada
- Information for Employers for Workers Compensation – Nevada
- Information for Injured Workers – Nevada
- Medical Services Order Form – Idaho, Nevada, Oregon
- Notice of Injury or Occupational Disease – Nevada
- D-1 and D-2 Poster
- D-1 Poster
- D-2 Poster
- Wage Verification Form – Nevada
- Fatality Report – Nevada
- Notice to Employees – Nevada
- Alternate Choice of Physician – Nevada
Oregon Claims Materials
- Employers’ Report of Injury – Oregon
- Employers’ Report of Injury (Spanish) – Oregon
- A Guide for Workers Hurt on the Job – Oregon
- A Guide for Workers Hurt on the Job (Spanish) – Oregon
- Information for Employers for Workers Compensation – Oregon
- Information for Injured Workers – Oregon
- Medical Services Order Form – Idaho, Nevada, Oregon
- Spanish Claim Form – Oregon
Utah Claims Materials
- Employer’s Report of Injury – Utah
- Information for Employers for Workers Compensation – Utah
- Information for Injured Workers – Utah
- Information for Injured Workers (Spanish) – Utah
- Injured Worker’s Right and Responsibilities – Utah
- Injured Worker’s Right and Responsibilities (Spanish) – Utah
- Medical Services Order Form – Arizona, Colorado, Utah
- Workplace Safety and Health
- Workplace Safety and Health – Spanish
- Workers’ Compensation Notice Poster – Utah
- Workers’ Compensation Notice Poster (Spanish) – Utah
- Workers’ Compensation Temporary Prescription ID Card
