- Amputation Chart (form 7) FootFile .pdf (388.8 Kbytes)
- Amputation Chart (form 7) HandFile .pdf (646.8 Kbytes)
- Application For Individual Self-insurance (in Html Format)External Link
- Claim For Benefits Application (form InFile .doc (138 Kbytes)
- Claim For Unpaid WagesFile .pdf (21.3 Kbytes)
- Claimant`s Affidavit (form In Html Format)External Link
- Contractor`s Certification Of Insuring Liability For Workers` Compensation In VirginiaFile .pdf (212.9 Kbytes)
- Employer Account Change Notice - Form Vec-fc-20cFile .pdf (15.4 Kbytes)
- Employer`s Application For Hearing (requires Blue)File .pdf (36.9 Kbytes)
- Employer`s Report (form InFile .doc (44.5 Kbytes)
- Garnishment Instructions (fairfax County)File .pdf (50.4 Kbytes)
- Garnishment Show Cause Order (fairfax County)File .pdf (25.5 Kbytes)
- Handbook For Claimants & Job SeekersFile .pdf (168.1 Kbytes)
- Incident Report FormFile .pdf (182.2 Kbytes)
- Informational Letter Where Employee Is Not Represented By Counsel (form In Html Format)External Link
- Initial Claim For Workers` Compensation Benefits (blue Paper)File .pdf (195 Kbytes)
- Instructions For Mass Filing Of Initial & Additional ClaimsFile .pdf (139.2 Kbytes)
- Instructions For Preparing The Report To Determine Liability For State Unemployment Tax - Form Vec-fc-27bFile .pdf (19.7 Kbytes)
- Interstate Claim Filing By Telephone & InternetFile .pdf (101.3 Kbytes)
- Job Seeker Information BrochureFile .pdf (314.3 Kbytes)
- List Of Required Employer PostersFile .pdf (22.6 Kbytes)
- Lump Sum AgreementFile .pdf (73.5 Kbytes)
- Magnetic Reel Tape & 3480 CartridgesFile .pdf (18.2 Kbytes)
- Mailing List FormFile .pdf (102.2 Kbytes)
- Motion & Notice Of Proposed Income Deduction Order For SupportFile .pdf (111.7 Kbytes)