How to file Form 30C
Building Permit forms
Coverage Election
First Report of Injury (FRI) request
Hearing forms
Medical forms
Rehabilitation form
Stipulation and commutation
Self-insurance and managed care plan applications
Worksheets
Where can I get forms and worksheets for W-2 workers?
How to file Form 30C
Find important workers’ compensation forms here, including Form 30C (PDF) and Hearing Request (PDF). Please note that the Workers’ Compensation Commission (WCC) can’t give legal advice or pay benefits. The WCC doesn’t provide or authorize medical treatment.
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Note: It’s very important that you file a claim with your employer. If you wait, it may be more difficult to prove that your injury or illness is work-related. You should consider getting a signed and dated receipt from them. You can also request a return receipt when you mail the form by certified or registered mail.
Complete and send us Form 30C: Notice of Claim for Compensation (PDF) as soon as possible. Doing so helps to protect your right to get benefits. You must submit the form within one year of getting injured. Instructions on the form tell you how to send a copy of the form to:
- The right WCC district office
- And your employer
Make sure you:
- Keep a copy of your completed form
- File in time!
If benefits are delayed or denied, you can request a hearing with a WCC administrative law judge.
Download Hearing Request form (PDF) here
Learn which forms to send with our Electronic Form Submission Service
Already filed a claim? check its status with the Claim and Hearing Look-up Tool
Use GovQA to request claim files, documents, and more
Building Permit forms
Form 7A-7B-7C directions: Building Permit Requirements for Workers’ Compensation (PDF) - This sheet tells you how to fill out Forms 7A, 7B, and 7C when applying for a building permit.
Form 7A: Proof of Workers’ Compensation Coverage when Applying for a Building Permit for the Sole Proprietor or Property Owner who WILL NOT act as General Contractor or Principal Employer (PDF) - Use this form if you own the property, are not the main contractor, and need a building permit.
Form 7B: Proof of Workers’ Compensation Coverage when Applying for a Building Permit for the General Contractor or Principal Employer who has chosen to be EXCLUDED from Coverage (PDF) - Use this form if you own the property and are the main contractor for the building work.
Form 7C: Proof of Workers’ Compensation Coverage when Applying for a Building Permit for the General Contractor or Principal Employer who has chosen to be EXCLUDED from Coverage (PDF) - Use this form if you are a contractor who filed not to have workers' comp and are applying for a building permit.
Learn which forms to send with our Electronic Form Submission Service
Use GovQA to request claim files, documents, and more
Coverage Election
You can send a few forms electronically, thanks to our Electronic Form Submission Service. These forms include Form 6B, and eventually others. You can send the form here:
6B, 6B-1, and 75 directions (PDF) - The Directions form explains how to fill out and send Forms 6B, 6B-1, and 75 to make or change coverage choices.
Form 6B: Coverage Election by Employee Who is an Officer of a Corporation or a Member of an LLC (PDF) - Lets a company officer or LLC manager say they don’t want workers’ comp coverage or take back that choice.
Form 6B-1: Coverage Election by Employees who are Members of a Partnership (PDF) - Lets partners in a business say they don’t want workers’ comp coverage or take back that choice.
Form 75: Coverage Election by Sole Proprietor (PDF) - Lets a sole business owner choose to have workers’ comp coverage or take back that choice.
Find more information on self-insurance and managed care plans
Learn which forms you can send with our Electronic Form Submission Service
Use GovQA to request claim files, documents, and more
First Report of Injury (FRI) request
First Report of Injury (FRI) (PDF) - Tells WCC if a worker gets hurt or sick on the job and misses at least one day of work.
Use GovQA to send forms, request important documents, verify coverage, and more
Hearing forms
Hearing Request (PDF) - Ask for an Informal, Pre-Formal, Formal, Stipulation Approval, or Disfigurement/Scar hearing. It will happen before an administrative law judge in one of the Commission's eight district offices.
Hearing Cancellation Request (PDF) - Ask to cancel a meeting about a workers’ compensation claim.
Petition for Review (PDF) - File an appeal with the WCC Compensation Review Board (CRB).
Learn which forms to send with our Electronic Form Submission Service
Learn how to request a hearing
Use GovQA to request claim files, documents, and more
Medical forms
Authorization for Release of Medical Records (PDF) - Use it to ask for medical records for a workers’ comp claim.
Employee Medical & Work Status Form (PDF) - Report a worker’s progress and abilities to a payor.
Learn which forms to send with our Electronic Form Submission Service
Learn how to get medical treatment
Use GovQA to request claim files, documents, and more
Rehabilitation form
WCR-1: Rehabilitation Request (PDF) - For the injured worker to ask for help with job training or recovery.
Learn which forms to send with our Electronic Form Submission Service
Use GovQA to request claim files, documents, and more
Stipulation and commutation
Stipulation Approval Procedure (PDF) - An information document that explains the steps to follow before and during a Stipulation Hearing.
Stipulation and What it Means (English) (PDF) - Says the claimant agrees to end their case for good. The claimant must sign it before asking for a Stipulation Hearing.
La Estipulacion y lo que Significa (Español) (PDF)
Stipulation To Date and What it Means (PDF) - To settle benefit claims up to the date of approval. The claimant must sign it before asking for a Stipulation Hearing.
Stipulation Questionnaire (PDF) - Asks important questions and must be filled out before asking for a Stipulation Hearing.
Learn which forms to send with our Electronic Form Submission Service
Use GovQA to request claim files, documents, and more
Self-insurance and managed care plans
Learn about and get contact information for the Self-Insurance and Managed Care Plans Unit. It does the following:
- Reviews and approves applications from employers to self-insure workers' comp liabilities
- Reviews and approves new managed care plan applications
- Also reviews and approves employer applications for existing managed care plans
- Download Employer Medical Care Plans Information Packet (PDF)
- Download Employer Self-Insurance Information Packet (PDF)
Get self-insurance and managed care plan information and applications
Learn which forms to send with our Electronic Form Submission Service
Use GovQA to request claim files, documents, and more
Worksheets
Log your miles for medical treatment or physical therapy. Note: these forms are not official WCC ones. We don’t pay benefits, give, or authorize medical treatment.
Mileage Worksheet (PDF) - Use this worksheet to track your travel for doctor visits or other medical appointments related to your work injury.
Record of Employment Contacts (PDF) - Use this worksheet to list the jobs you apply for while out on workers' comp.