These forms are available for completion and online submission through the Board's website.
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.
| Form Number | Form Title | Registration required? | Comments |
|---|---|---|---|
| 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. |
| RFA-1W| | Request for Assistance By Injured Worker | No | The form may be filed at any time after the indexing of a
claim or after the Board has indicated that no further action (NFA) will
be taken. REPLACES FORM C-89.3.
Note: When filing required documents (e.g. medical evidence indicating permanency), provide the appropriate document identification if it is already in the case folder. |
| VDF-1 | Loss of Wage Earning Capacity Vocational Data Form | No | Injured Workers who may have a non-schedule permanent impairment and who have not returned to work are encouraged to complete and submit Form VDF-1 as early as possible in the claim. |
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.