Workers Compensation Forms for all 50 States | State Forms and Information | Claimwire: Workers' Compensation Resource for Forms and Information

Register Login

Arizona Forms

17 State Forms found

name	number	revision	print or send online
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 PROFESSIONAL EMPLOYER AGREEMENT	Claims ICA 0123	Rev 08.01.16
PETITION TO REOPEN BASED ON NEW, ADDITIONAL OR PREVIOUSLY UNDISCOVERED DISABILITY OR CONDITION	Claims ICA 0528	Rev 05.15.17
REQUEST TO LEAVE THE STATE	Claims ICA 0122	Rev 07.01.13
Notice of Suspension of Benefits	Form ICA 0105	Rev 6/2019
Serious Event Reporting Form	ADOSH ICA 2212	Rev 08.01.16
EARNED PAID SICK TIME	Labor ICA 3305	Revised February 2022
SELF-INSURER NOTICE TO COMMISSION OF CHANGE IN COVERAGE SITE	No Form Number	No Form/Rev Date
Preferred Communication Method	No Form Number	No Form/Rev Date
CUSTODY AGREEMENT	No Form Number	No Form/Rev Date
SELF-INSURER STATUTORY DEPOSIT AGREEMENT FOR LOCAL GOVERNMENT INVESTMENT POOL	No Form Number	No Form/Rev Date
PARENT COMPANY GUARANTY	No Form Number	No Form/Rev Date
Request for Waiver from Requirement to Post Statutory Deposit	No Form Number	No Form/Rev Date
Compliance Assistance Request Form	No Form Number	No Form/Rev Date

1
2

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.

Loading results ...

Origami Risk

1379 N 1075 W, Suite 226,
Farmington, UT 84025
312.546.6515
info@origamirisk.com

© 2025 Origami Risk. All Rights Reserved.