Forms/Laws

Utah Forms

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 92 State Forms found

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ATTENDING PHYSICIAN'S STATEMENT

 Form 043 Rev 10/2019

EMPLOYER’S FIRST REPORT OF INJURY OR ILLNESS

 Form 122E Revised 7/2024

Physician’s Initial Report of Work Injury or Occupational Disease

 Form 123 Rev 7/2024

RELEASE TO RETURN TO WORK- EDI ONLY

 Form 110 Revised 05/16

Application for Authorization to Employ a Minor

 No Form Number 2-12

APPLICATION FOR HEARING - DEPENDENT’S BENEFITS and / or BURIAL BENEFITS Industrial Accident Claim

 Form 025 3/1/12

Application For Hearing Failure Of Diligent Pursuit

 Form 502 3/1/12

APPLICATION FOR HEARING Industrial Accident Claim

 Form 001 07/01/18

APPLICATION FOR HEARING MEDICAL CARE PROVIDER

 Form 024 6/18/14

APPLICATION FOR HEARING NONCOOPERATION

 Form 602 3/1/12

APPLICATION FOR HEARING FOR TERMINATION OR REDUCTION OF COMPENSATION

 Form 402 3/1/12

APPLICATION FOR LUMP SUM OR ADVANCE PAYMENT

 Form 134 5/16

APPLICATION TO CHANGE DOCTORS

 Form 102 Rev 07/2024

APPOINTMENT OF COUNSEL

 Form 152 Revised 6/20/16

Authorization Request for Medical Treatment / Carrier Response

 Form 223 Rev 7/2024
Disclaimer: These forms may not be the most recent version. Utah 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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