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Hawaii Workers Compensation Forms

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Workers Compensation Shop.com is your source for workers compensation quotes, information, and forms for Hawaii.  We have compiled a list of downloadable forms, brochures, and guides for HI employers and employees.  Contact us if you need help locating a form or have questions about your policy or coverage in general.  One of our HI Workers Comp Specialists are ready to assist you.

Find out if your business qualifies for lowers rates, premium discounts, and policy credits.  To get started on a Hawaii workers compensation quote click the state on the right or call 888.611.7467.

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Questions? Call 888.611.7467 for a Workers Compensation Shop Specialist

 

 HI Comp Forms

 

Hawaii Workers Compensation Forms

Hawaii Acord 130 Workers Compensation Application

The standard Acord 130 application form for workers comp coverage in Hawaii.

Hawaii First Report of Injury Form

First Report of Injury Form.  Employers should complete this form and send to their insurance company each time an injury occurs.

Hawaii Workers Compensation Laws- Form WC-101

The Hawaii Department of Labor and Industrial Relations requires that all HI employers provide this brochure to employees within 3 days of an injury.

Hawaii Application for Exclusion of Officers and Stockholders

Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.

Hawaii Employee Claim Form

Complete this form to file for a workers' compensation claim.

Hawaii Employee Claim Form

Complete this form to file for a workers' compensation claim for a claimant that is deceased.

Application for Safety and Health Certification

Hawaii Occupational Safety and Health Professional Application for certification

Facts for Injured Workers In Hawaii

Information about workers compensation in Hawaii for workers and employers.


State Resources for Hawaii

State of Hawaii

www.hawaii.gov/portal/

HI Department of Labor & Industrial Relations (DLIR)

www.hawaii.gov/labor/
830 Punchbowl Street
Honolulu, Hawaii 96813
(808) 586-8842

HI Disability Compensation Division

www.hawaii.gov/labor/dcd/

index.shtml
830 Punchbowl Street, #211
Honolulu, Hawaii 96813
(808) 586-9151

HI Labor & Industrial Relations Appeals Board

www.hawaii.gov/labor/hlirab/

index.shtml
830 Punchbowl Street #404
Honolulu, Hawaii 96813
(808) 586-8600

Hawaii Insurance Division
HI Dept. of Commerce & Community Affairs

 www.state.hi.us/dcca/ins
P.O. Box 3614
Honolulu, HI 96811
808-586-2790
www.state.hi.us/dcca/ins

Department of Labor & Industrial Relations (DLIR)

www.dlir.state.hi.us

 

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Hawaii Work Comp Compliance

Injured employees who work for an employer that does not provide workers compensation insurance should contact the Hawaii Investigation Section or the Department of Labor and Industrial Relations District Office.

 

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