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-11||Employer's Report of Injured Employee's Change in Employment Status Resulting From Injury||No||As soon as employment status of injured employee changes.|
|C-240||Employer's Statement of Wage Earnings||No||Within 10 days of request by the Board.|
|PH-16.2||Pre-Hearing Conference Statement||No||Filed 10 days before scheduled pre-hearing conference for controverted cases (FROI-04/SROI-04).|
|RFA-2|||Request for Further Action By Carrier/Employer||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.
Note: When filing required documents (e.g. medical evidence indicating permanency), provide the appropriate document identification if it is already in the case folder. If faxing or mailing documents, be sure that each page is properly identified by the Board case number, claimant name and date of injury.
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.