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  • Workers Compensation Accident Report Fillable Form For Arizona 2009

Get Workers Compensation Accident Report Fillable Form For Arizona 2009-2025

Ment at no cost. Please follow the procedure below. 1. When injured, notify your supervisor IMMEDIATELY. 2. Note: If the injury involves a needle stick or a cut from a sharp that could have been contaminated with blood or other bodily fluid, wash exposed area with soap and water, seek medical attention immediately and notify your supervisor. Inform your medical provider of the possibility of a blood borne contamination exposure. You and your department should contact EH&S immediately at 829-3301.

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Claims - Filing a Claim A claim is made either by filling out and signing a Worker's and Physician's Report of Injury at the doctor's office or by obtaining a Worker's Report of Injury (use download link directly above to obtain report form) from the ICA, and filing either report with the ICA.

Form ICA-04-0101 Employer's Report of Industrial Injury. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of an accident. Fatalities must be reported within 24 hours.

Immediately following the accident, you should notify your employer and seek medical attention. Your employer is then required to provide you certain information such as the name and address of their workers' compensation insurance carrier, the policy number, and the date of expiration of coverage.

How much does workers' compensation insurance cost in Arizona? Estimated employer rates for workers' compensation in Arizona are $0.78 per $100 in covered payroll. Your cost is based on a number of factors, including: Payroll.

Worker's Report of Injury Form.

Form 102 is required by the Industrial Commission of Arizona for a Physician's Initial Report of Injury. The report must be made using or by attaching a report to the form.

Arizona's workers' compensation statute of limitations requires an injured worker to report his or her work-related injury within 1 year from the date of injury. If the worker doesn't file a claim before the 1 year deadline, he or she may forfeit their right to receive compensation.

All workers, regardless of whether they are full or part-time, must be covered. You must be an employee: Working somewhere does not automatically classify you as an employee. Independent contractors, occasional and casual workers, and domestic workers are typically not covered by workers' compensation in Arizona.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232