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Adjudication Division
Antidiscrimination and Labor Division
Division of Boiler and Elevator Safety
Industrial Accidents Division
Utah Occupational Safety and Health Division
Workplace Safety
Commissioner Decisions
Appeals Board Decisions
Annual Report
On-The-Job Quarterly Newsletter
Applications For Hearing
Industrial Accident Claim
Occupational Disease Claim
Medical Care Provider
Applications for Dependant's Benefits and/or Burial Beneftis
Industrial Accident Claim
Occupational Disease Claim
Death Benefits
Employee's Guide to a Worker's Compensation Hearing
Medical Provider Application for Hearing
Summary of Medical Records or Actual Medical Records Supporting your Claim
List of Medical Providers
Authorization to Release Medical Records
Appointment of Counsel
Dependent's Benefit Information
Claim for Dependent's Benefits and/or Burial Benefits
Claim Form for Continued Dependent Benefits after 312 Weeks
Employment Discrimination Intake Form
Employment Discrimination Intake Form
Spanish
Instructions on Filing an Employment Discrimination Complaint (English/Spanish)
New Employment Publication
ADA Intake Form
Housing Discrimination Intake Form
Housing Discrimination Intake Form Spanish
Fair Housing Flyer
Fair Housing Pamphlet
Sample Nondiscrimination Policy
Wage Claim Form
Wage Claim Form Spanish
Boiler/Pressure Vessel Compliance Manual
Elevator Compliance Manual
Division Codes
Variance Request
Mine Certification Test Application
Forms
001 Application for Hearing Industrial Accident Claim
024 Application for Hearing Medical Care Provider
025 Application for Dependents Benefits and/or Burial Benefits - Industrial Accident Claim
026 Application for Hearing Occupational Disease Claim
027 Application for Dependant's Benefits and/or Burial Benefits - Occupational Disease Claim
043 Attending Physician's Statement
044 Employee's Intent to Leave State/Change Dr./Hospital
046 Authorization to Release Adjudication Division Records
089 Employee Notification Denial of Claim
102 Application to Change Doctors
110 Release to Return to Work
113 Summary of Medical Records
122 Employer's First Report of Injury or Illness
123 Physicians First Report of Injury or Illness
130 Insurance Company's/Self Insured Final Report of Injury/Statement of Total Loss
134 Application for Lump Sum or Advance Payment
141 Initial Statement of Insurance Carrier/Self Insurer with Respect to Payment of Benefits
142 Statement of Insurance Carrier/Self Insurer with Respect to Discontinuance of Benefits
151 Dependent's Benefit Order
152 Appointment of Counsel
198 Insurer Request for Extension of Time to Obtain 2nd Dental Opinion
205 Request for Copies from Industrial Accident Division
206 Insured Workers Status Report
219 Compensation Agreement
221 Restorative Services Authorization/Denial Form
223 Authorization Request for Medical Procedures
302 Medical Records - Copies
307 Medical Treatment Provider List - Industrial Accidents
308 Authorization to Disclose Health Information - Industrial Accidents
308A Authorization to Disclose Health Information - Adjudication
309 Medical Treatment Provider List - Industrial Accidents
309A Medical Treatment Provider List - Adjudication
310 Request/Appeal for Additional Medical Information
350 EMS Form 350
401 Request for Claims Resolution Conference
441 Insurance Carrier/Self Insurers Notice of Further Notification of WC Claim
SUB Subpoena
Posters
Post Workers' Compensation Poster - English
Post-S Workers' Compensation Poster - Spanish
Statistics
2006 Age of Injured Employee
2006 Injuries by Body Part Injured
2006 Number of Injuries by County
Occupational Fatality Data
Publications
Medical Fee Guidelines 2007 Schedule
2007 WC Handbook for Physicians
2006 Impairment Guides
Employee's Guide to Workers' Compensation
Employee's Guide to Workers' Compensation (Spanish)
Employer's Guide to Workers' Compensation
Bulletins
Feb. 2007 Bulletin - How to Compute Average Weekly Wage
January 2007 Bulletin - Medical Releases/Adjustor Information
5-1-2006 Bulletin - Average Weekly Wage, Medical Fee Schedule and Ambulance Rates
7-1-2005 Bulletin - New Rules
5-14-2004 Bulletin - 2004 Average Weekly Wage & Medical Fee Schedule
6-27-2003 Bulletin - Medical Records Rule/Medical Fee Schedule
2-22-2003 Bulletin - Restorative Services Auth Form 221, Medical Fee Sched Update, Rule Changes
11-15-2002 Bulletin - Hospital/Facility Charges
6-6-2002 Bulletin - Rule Changes, 2002-2003 Avg Weekly Wages, Employers' First Report of Injury
6-06-2000 Bulletin - 1-Avg Weekly Wage Update, 2-RBRVS Fee Sched to Become Effective 1/2001
9-25-2000 Bulletin - Mileage, Medical Fee Schedule
11-22-2000 Bulletin - Medical Fee Schedule
2-2001 Bulletin - Clarification of Unit Values
3-2001 Bulletin - Emergency Rule Related to Medical Fee Guidelines
5-2001 Bulletin - 2001/2002 Average Weekly Wage and Rule Changes to R612-25
#11-01 Bulletin - Policy Reporting Penalties
11-01-00 Bulletin - Penalties
10/01 Bulletin - Reemployment Forms
Policy Information
Self Insurance Renewal Application Word Format
Guarantee by Parent Company
Proposed surety bond Claims Administration
Bankruptcy and Insolvency Endorsement
Self Insurance Application
Complaint Form
Employer's First Report of Injury
OSHA Form 300 and 300A (Log and Summary)
Injury, Illness and Fatality Data
Consultation Request Form
Files and Government Records Access Requests (GRAMA)
Utah Occupational Safety and Health Poster-English
Utah Occupational Safety and Health Poster-Spanish
Utah Occupational Safety and Health Discrimination Poster
Employer Responsibilitites and Courses of Action Following a UOSH Inspection English Spanish
Grant Application
Project Summary
Scope of Work and Project Description
Budget Form FY 2008
Statement of Work Progress Report