Free Arizona Workers Comp Forms

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35 Forms found in Arizona — Workers Comp — Page 1 of 1
Title Last Updated
Workers Report Of Injury February 3, 2014
Wage Claim February 3, 2014
Self-Insured Hospital Report February 3, 2014
Request To Leave The State February 3, 2014
Request To Change Doctors February 3, 2014
Public Complaint Referral Report February 3, 2014
Petition To Reopen Based On New, Additional Or Previously Undiscovered Disability Or Condition February 3, 2014
Notice Of Alleged Health Or Safety Hazards February 3, 2014
Consultation And Training Request Form April 3, 2009
Report Of Annual Workers Compensation Administrative Fund-Special Fund Premium Tax Form 100 February 4, 2009
Employment Agency Bond February 4, 2009
Workers Compensation Liability Form January 20, 2009
Self-Insured Payroll Report January 19, 2009
Self-Insured Medical Report January 19, 2009
Insurance Carrier Quarterly Administrative-Special Fund Tax Forms 101 C January 19, 2009
Self-Insurers Quarterly Administrative-Special Fund Tax Form 103 January 19, 2009
Self-Insured Injury Report October 13, 2008
Petition For Rearrangement Or Readjustment Of Compensation April 30, 2007
Employers Report Of Industrial Injury April 30, 2007
Initial Application For Authority To Self Insure (Individual) May 30, 2006
Self Insurance Workers Compensation Guaranty Bond April 27, 2006
Supplemental Application (For Responsible Managing Agents) May 25, 2005
Self-Provider Of Medical Benefits May 25, 2005
Personal Financial Statement May 25, 2005
Notice Of Self-Insurers Termination Of Self-Insurance Form May 25, 2005
Discrimination Statement May 25, 2005
Business Financial Statement May 25, 2005
Application For Employment Agency License May 25, 2005
Request For Hearing May 18, 2005
Initial Application For Authority To Self Insure (Pool) November 22, 2004
Option Election Form For Workers Compensation Pools (Self Insured Employer) November 22, 2004
Waiver Of Right Of Rehearing And Appeals January 12, 2004
Notice Of Professional Employer Agreement January 12, 2004
Employment Agency Complaint January 12, 2004
Claim For Dependents Benefits - Fatality January 12, 2004