Virginia Workers Comp Forms

Find Virginia workers compensation forms and coverage guides.

Find helpful workers compensation guides, forms and resource for Virginia employers and employees in our forms library. We provide free access to the most common VA work comp forms for your convenience. Please contact our agency if you have questions about our forms or coverage in general, or if you need assistance locating a particular state form.

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Virginia Workers Compensation Insurance Forms

VA Acord 130 Workers Compensation Application

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

Virginia First Report of Injury Form

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

Virginia Agency Change of Address Form

VA Agencies should complete this form to update their contact information in the state of Virginia.

Virginia Agency Contact Addition-Change Form

Agencies should complete this form to add new contacts and update contact information.

VA Electronic Data Interchange Implementation Guide

This Implementation Guide is designed to assist Insurers, Self Insurers, and Claim Administrators with the transition from paper filing to electronic filing of first and subsequent reports of injury.

Virginia LLC Rejection of Workers' Compensation Coverage

This form allows LLC members to reject workers comp coverage for the state of Virginia.

Virginia Drug-Free Workplace Certification Checklist

Complete this form to apply for the Drug-Free workplace premium reduction.

Facts for Injured Workers in Virginia

Information about workers' compensation in Virginia for Injured Workers.

Employers Guide to Workers' Compensation

Information from The Virginia Workers' Compensation Commission about workers' compensation for employers in Virginia.

Workers' Compensation Notice

Information from the Virginia Workers' Compensation Commission about the filing process for compensation claims.

Irrevocable Letter of Credit

A publication by the VA Division of Workers' Compensation about the states Second Injury Fund.

State Resources for Virginia

Virginia Workers' Compensation Commission

1000 DMV Drive
Richmond, Virginia 23220
877-664-2566
Virginia Workers' Comp Commission

VA Bureau of Insurance (BOI)

Tyler Building
1300 E Main Street
Richmond, VA 23218
800-552-7945
State Corporation Commission

Workers compensation insurance is required by law for Virginia employers.

Virginia forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers compensation form your need for Virginia. We make every effort to keep forms updated but cannot guarantee any form is the latest version available.

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Visit NCCI for more resources and information about workers' compensation class codes. Visit United States Department of Labor for more information about government agencies managing workers compensation insurance rates.

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