Indiana Workers' Compensation Forms
- First Report Of Injury - Must Be Sent Electronically To Board
- Independent Contractor Affidavit. New Changes Effective July 01,2001
- Application For Review By Full Board - Form 1042
- Agreement To Compensation - Form 1043
- Report Of Claim Status/Ime Request - Form 38911
- Application For Adjustment Of Claim - Form 29109
- Request For Assistance - 45442
- 2nd Injury Fund Assessment Recomendation
- 2nd Injury Fund Notice Of Assessment
- 2nd Injury Fund Certificate
Occupational Safety and Health Administration
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