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Workers Compensation Form IA-1

Workers Compensation Form Example

Workers Compensation Form IA-1 Supplement

Lost Time and Return to Work Form


Participation and Release Form  - (Maintain the release form(s) in your department)                            

 

Auto Insurance Card

Motor Vehicle Records Check Release Form (MVR) - Use this form when requesting a MVR check, please do NOT send a copy of drivers license.



Incident Mini-Form - DO NOT use this form for any employee related injury.  See Workers Comp.

Use the above form to report an incident to Risk Management. Incidents should also be immediately reported to DPS.

 

Agent/Broker Form -The Risk Management Department will use the contact information submitted as contacts for insurance Request for Proposals.            

                                    



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