Workers' Compensation Forms

Below are frequently used Workers’ Compensation forms such as Workers’ Compensation certificate of insurance requests and Workers’ Compensation employer’s report of employee’s injury or illness forms categorized by state.

Workers’ Compensation Certificate of Insurance Request

The Insurance Certificate is written proof that workers compensation coverage is being provided for a certain group of workers. It is used to provide proof that a workers compensation policy is in place.

Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission (NC Form 19)

Employer’s report of employee’s injury or occupational disease to the North Carolina Industrial Commission.

First Report of Injury or Illness (SC Form 12a)

Employer’s report of employee’s injury or illness to the S.C. Workers’ Compensation Commission.

Employer’s First Report of Injury or Occupational Disease (GA Form WC-1)

Employer’s report of employee’s injury or occupational disease to the Georgia State Board of Workers’ Compensation.

Employer’s First Report of Work Injury or Illness (TN Form C20)

Employer’s report of employee’s work injury or illness to the Tennessee Department of Labor and Workforce Development.