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Workers Compensation for Arkansas

  • Accident Prevention Services Annual Report
    File .pdf (82.3 Kbytes)
  • Accident Prevention Services Worksheet
    File .pdf (74 Kbytes)
  • Application For Membership In A Group
    File .pdf (111.9 Kbytes)
  • Apss/fsr Application
    File .pdf (325.9 Kbytes)
  • Claim For Compensation
    File .pdf (252.5 Kbytes)
  • Death/ptd Acceptance/update
    File .pdf (294.5 Kbytes)
  • Employer's Intent To Accept Or Controvert
    File .pdf (316.6 Kbytes)
  • First Report Of Injury Or Illness
    File .pdf (255.1 Kbytes)
  • Group Self-insurance Application
    File .pdf (312.9 Kbytes)
  • Hazard Survey Report
    File .pdf (154.4 Kbytes)
  • Health & Safety Plan Cover Sheet
    File .pdf (259.5 Kbytes)
  • Health Notice For Managed Care
    File .pdf (294.4 Kbytes)
  • Individual Self-insurer Application
    File .pdf (385.9 Kbytes)
  • Insurance Coverage Verification Card
    File .pdf (378.9 Kbytes)
  • List Of Fsr/apss
    File .pdf (229.9 Kbytes)
  • Lump Sum Request/respondent's Position
    File .pdf (244.2 Kbytes)
  • Monthly Medical-only Injury Data
    File .pdf (206.8 Kbytes)
  • Notice To Employer/notice To Employee
    File .pdf (161.6 Kbytes)
  • Notification Of Potential Data Error
    File .pdf (293.7 Kbytes)
  • Physician's Report
    File .pdf (251.8 Kbytes)
  • Policyholder Questionnaire
    File .pdf (355.5 Kbytes)
  • Poster Of Instructions
    File .pdf (40.8 Kbytes)
  • Report Of Compensation Paid/suspension Report
    File .pdf (318.3 Kbytes)
  • Report Of Mediation Conference
    File .pdf (228.3 Kbytes)
  • Supplemental Report
    File .pdf (235.5 Kbytes)
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