Workers Compensation Forms

Free access to one of the most complete workers compensation form library available anywhere online.

Work Comp Forms

Welcome to Our Free Workers Compensation Form Center

Workers Compensation Shop.com provides access to our collection of forms with no guarantees or warranties. We make every reasonable effort to keep our forms library up-to-date and current with the most recent insurance forms available. Visit our State Form pages listed below for state-specific forms.

Questions? Call 888.611.7467 for a Workers Compensation Specialist

Workers Comp Forms- General

Acord 130 Work Comp Application Form
The standard workers compensation insurance application for work comp and employers liability coverage. Form not applicable for Florida quotes.

Acord 4 First Report of Injury Form
This form should be completed anytime an employee is inured on the job, or claims to be injured. Employers are required to report all injury claims to the insurance company within 7 business days from the 5th day of disability.

Workers Compensation Loss Affidavit
A workers comp loss affidavit should be completed by prospects seeking coverage when they are unable to obtain official loss runs from their insurance company or current agent of record.

Workers Compensation Loss Runs Request Form
This form may be used to request loss runs from your current agent of record or insurance company.

Agent of Record Change Request Form
Complete this form if you would like to change the agent of record from your current agent or agency to Workers Compensation Shop/The Insurance Shop as the agent on file with the carrier. This will enable us to service your policy and work with the insurance company and NCCI on your behalf.

Experience Mod Release Authorization Form
Complete this form in order to authorize NCCI to release your experience modification worksheets to our agency.

Acord 35 Cancellation Request - Policy Release
Complete this form in order to officially cancel an active or renewal policy with an existing insurance company. Most insurance carriers will continue to charge premium until this form is returned to them.

ERM 14 Form
ERM 14 Instructions
Complete this form if there has been any change in ownership for any existing workers comp policy. The form may be submitted to the rating organization by the insured, agent, or insurance company.

Workers Comp Forms by State

Alabama Forms	Montana Forms
Alaska Forms	Nebraska Forms
Arizona Forms	Nevada Forms
Arkansas Forms	New Hampshire Forms
California Forms	New Jersey Forms
Colorado Forms	New Mexico Forms
Connecticut Forms	New York Forms
Delaware Forms	North Carolina Forms
Florida Forms	North Dakota Forms
Georgia Forms	Ohio Forms
Hawaii Forms	Oklahoma Forms
Idaho Forms	Oregon Forms
Illinois Forms	Pennsylvania Forms
Indiana Forms	Rhode Island Forms
Iowa Forms	South Carolina Forms
Kansas Forms	South Dakota Forms
Kentucky Forms	Tennessee Forms
Louisiana Forms	Texas Forms
Maine Forms	Utah Forms
Maryland Forms	Vermont Forms
Massachusetts Forms	Virginia Forms
Michigan Forms	Washington Forms
Minnesota Forms	Washington DC Forms
Mississippi Forms	West Virginia Forms
Missouri Forms	Wisconsin Forms
	Wyoming Forms- no forms