Evaluation Of Accident Prevention Services Of Arkansas Workers Comp Insurance Carriers
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Evaluation Of Accident Prevention Services Of Arkansas Workers Comp Insurance Carriers Form. This is a Arkansas form and can be use in Workers Comp.
Loading PDF...
Tags: Evaluation Of Accident Prevention Services Of Arkansas Workers Comp Insurance Carriers, HS-31-E, Arkansas Workers Comp,
ARKANSAS WORKERS’ COMPENSATION COMMISSION
Form HS-31-E
HS31-E
HEALTH & SAFETY DIVISION
324 Spring Street, Little Rock, AR 72201
Mail: P. O. Box 950, Little Rock, AR 72203-0950
501-682-3930 / 1-800-622-4472
Ark. Code Ann.
§11-9-409(d) &
AWCC R ule 31
Rev. 1-1-2001
Evaluation of Accident Prevention Services of Arkansas Workers' Compensation Insurance Carriers
List of Field Safety Representatives (FSR)/Approved Professional Safety Sources (APSS)
Status
Name
Current telephone no.
Employee
FSR no.
APSS
no.
C o n t r a c to r
________________________________________
Company Name
________________________________________
Prepared By (Name)
________________________________________
Date
HS-31-E
American LegalNet, Inc.
www.FormsWorkFlow.com
