Workers' Compensation Forms

NC Claims Forms
Form 17 - Notice to Injured Workers and Employers
Form 18 - Notice of Accident to Employer and Claim of Employee, Representative or Dependant 
Form 19 - Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission
Form 22 - Statement of Days Worked  and Earnings of Injured Employee
Form 25T - Itemized Statement of Charges for Travel

VA Claims Forms 
VWC Form 3 - Employer's Accident Report 
VWC Form 7A - Wage Chart

GA Claims Forms