Form 100 – Injured Workers’ Rights and Responsibilities

Form 100 – Injured Workers’ Rights and Responsibilities (Spanish)

Form 102 – Application to Change Doctors

Form 109 – Application for Self Insurance

Form 122 C – Insurance Carrier/Self Insured Employer First Report of Injury or Illness

Form 122 E – Employers First Report Of Injury or Illness

Form 123 – Physician’s Initial Report of Work Injury or Occupational Disease

Form 130 – Insurance Company’s and Self Insurer’s Final Report of Injury and Statement of Total Losses

Form 134 Application for Lump Sum or Advance Payment

Form 141 – Initial Statement of Insurance Carrier or Self Insurer With Respect to Payment of Benefits

Form 142 – Statement of Insurance Carrier or Self Insurer With Respect to Discontinuance of Benefits

Form 205 – Authorization to Release Industrial Accident Division Records