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.  Please allow 3 days for processing.

Incident Form - DO NOT  use this form to report any employee related injury.  The incident form is only to report an incident to Risk Management that does not involve an employee.  Incidents should also be reported to University of Louisville Police Department.

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

Auto Accident Form