Forms to Report an Injury
These forms are available for completion and online submission through the Board's web site.
The forms use Adobe Reader to render the form. Adobe Reader® 9 or later, is recommended to support the additional functionality in this form. The latest version of Adobe Reader® is available as a free download from Adobe's web site.
After the Board receives your form, a non-editable PDF version of the form will appear in your web browser. The first page contains a confirmation that your form was successfully submitted to the Board and the date. It should be saved for your records. DO NOT MAIL THIS FORM TO THE BOARD.
If a confirmation page does not appear in your web browser after you submit the form to the Board, then the Board did not successfully receive the form and you will need to resubmit it.
To access a form, select the form number or title.
|Form Number||Form Title||Registration required?||Comments|
|C-2||Employer's Report of Work-Related Injury/Illness||No||Must be filed within ten days after occurrence of accident.|
|C-3||Employee Claim||No||Must be filed within two years of injury, or within two years after employee knew or should have known that injury or illness was related to employment.|
|VF-2|||Political Subdivision's Report of Injury to Volunteer Firefighter||No||Must be filed within ten days after injury is incurred.|
|VAW-2|||Political Subdivision's Report of Injury to Volunteer Ambulance Worker||No||Must be filed within ten days after injury is incurred.|
If the form you are looking for is not available for online submission, you may print the PAPER version of the form from our list of common forms.