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Arizona Forms

95 State Forms found

name	number	revision	print or send online
EMPLOYER'S REPORT OF INDUSTRIAL INJURY	Claims ICA 0101	Rev 07.01.01
WORKER’S REPORT OF INJURY	Form 407	Rev 8/2024
Consultation Survey Request Form	ADOSH ICA 2217	Rev 08.01.16
CLAIM FOR DEPENDENT’S BENEFITS – FATALITY	Claims ICA 0120	Rev 05.15.17
DISCONTINUED BY STATE, NO REPLACEMENT - ADOSH POLICY AND PROCEDURE - Complaints	No Form Number - DEACTIVATED	August 1, 2006
DISCRIMINATION STATEMENT (Spanish)	ADOSH 81	Undated Form
DISCRIMINATION STATEMENT	ADOSH ICA 2215	Rev 06.17.19
EMPLOYEE’S NOTICE OF REJECTION OF TERMS OF THE ARIZONA WORKERS’ COMPENSATION LAW	Claims ICA 0113	Rev 3.20.25
EMPLOYEE’S NOTICE TO REVOKE REJECTION OF TERMS OF THE ARIZONA WORKERS’ COMPENSATION LAW	Claims ICA 0114	Rev 03.20.25
NOTICE OF ALLEGED SAFETY OR HEALTH HAZARDS	ADOSH ICA 2213	Rev 08.18.20
NOTICE OF PROFESSIONAL EMPLOYER AGREEMENT	Claims ICA 0123	Rev 08.01.16
NOTICE OF TERMINATION OF SELF-INSURANCE FORM	No Form Number	No Form/Rev Date
NOTICE OF ALLEGED SAFETY OR HEALTH HAZARDS (Spanish)	No Form Number	No Form/Rev Date
PETITION FOR REARRANGEMENT OR READJUSTMENT OF COMPENSATION	Claims ICA 0529	Rev 06.01.00
PETITION TO REOPEN BASED ON NEW, ADDITIONAL OR PREVIOUSLY UNDISCOVERED DISABILITY OR CONDITION	Claims ICA 0528	Rev 05.15.17

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Disclaimer: These forms may not be the most recent version. Arizona may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.

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