Massachusetts Claim Forms
Doctor’s Report of Treatment
Employee Incident Report
Employee Retraining Certification
Employee Retraining Certification – Spanish
Employer’s Documentation Sheet
Employer’s First Report of Injury or Fatality
Five Step Workers’ Compensation Checklist
Pre-Placement Physical
Supervisor’s Investigative Report
Supervisor’s Investigative Report – Home Care Industry
Transitional Modified Duty Agreement
Wage Schedule
Witness Statement
Witness Statement – Spanish
New Hampshire Claim Forms
Employee Incident Report
Employee Retraining Certification
Employer’s Documentation Sheet
Employer’s First Report of Injury or Fatality
Employer’s Supplemental Report of Injury or Fatality
Five Step Workers’ Compensation Checklist
Pre-Placement Physical
Supervisor’s Investigative Report
Supervisor’s Investigative Report – Home Care Industry
Transitional Modified Duty Agreement
Wage Schedule
Witness Statement
New Hampshire Workers’ Compensation Medical Form
Connecticut Claim Forms
Employee Incident Report
Employer’s First Report of Occupational Injury or Illness
Supervisor’s Investigative Report
Wage Statement
1A Filing Status and Exemption
Authorization for Release of Medical Records
Employee Medical & Work Status Form
Employee Retraining Certification
Employer’s Documentation Sheet
Five Step Workers’ Compensation Checklist
Pre-Placement Physical
Transitional Modified Duty Agreement
Witness Statement
Rhode Island Claim Forms
Doctors Report of Treatment
Employee Incident Report
Employee Retraining Certification
Employee’s Certificate of Dependency Status
Employers Documentation Sheet
Five Step Workers Comp Checklist
Patient Authorization to Disclose Health Information
Pre-Placement Physical
Supervisor’s Investigative Report
Supervisor’s Investigative Report – Home Care Industry
Wage Statement – Full Time
Wage Statement – Part Time
Wage Statement – Seasonal
Witness Statement
