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 61 State Forms found

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EMPLOYER'S FIRST REPORT OF ALLEGED OCCUPATIONAL INJURY, DISEASE OR FATALITY - EDI ONLY

 DWC-01 2001-01-03

PHYSICIAN’S NOTICE OF RELEASE TO WORK

DWC-27/28 (7/09)

Report of Indemnity Payment - EDI

 DWC-22 01/03

COORDINATION OF RETIREMENT BENEFITS

 DWC-36 (Rev. 01/2021)

ELECTION BY EXEMPT CORPORATE OFFICER TO BECOME SUBJECT TO WORKERS’ COMPENSATION (TITLE 28 CHAPTERS 29 through 38)

 DWC-11-C (6/2011)

Employee's Certificate of Dependency Status

 DWC-04 (Rev. 01/2021)

EMPLOYEE'S OBJECTION TO WAGE TRANSCRIPT

 DWC-31 (Rev. 01/2021)

INSURANCE COVERAGE CERTIFICATION For Temporary Employment and Employee Leasing Companies

 DWC-09 (11/05)

Itemized Statement of Compensation

 DWC-50 (Rev. 01/2021)

MEMORANDUM OF AGREEMENT

 DWC-02 (Rev. 01/2021)

Mutual Agreement

 DWC-24 (Rev. 01/2021)

Non-Prejudicial Agreement

 DWC-20 (Rev. 01/2021)

NOTICE OF CLAIM OF COMMON LAW RIGHTS PURSUANT TO R.I.G.L. §28-29-17

 DWC-11 (7/2024)

NOTICE OF DESIGNATION AS INDEPENDENT CONTRACTOR PURSUANT TO RIGL §28-29-17.1

 DWC-11-IC 01/24

NOTICE OF WITHDRAWAL OF DESIGNATION AS INDEPENDENT CONTRACTOR PURSUANT TO RIGL §28-29-17.1

 DWC-11-ICR (10/19)
Disclaimer: These forms may not be the most recent version. Rhode Island 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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