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Employer's Report of Injured Employee's change
in employment status resulting from injury (EC-11)
Adobe Format

This EC-11 form uses Adobe Reader to provide features such as saving the form data.   Adobe Reader® 9 or later, is recommended to support the additional functionality in this form. The latest version of Adobe Reader® Link to External Website is available as a free download from Adobe's web site.

For more information regarding how to use the save data, load data and other features of this form, please review Web Submission of Claim Forms - Adobe Format.