Forms

Workers Compensation Claim Forms

All forms should be completed and submitted immediately or no later than 24-hours of an incident or 8-hours if employee is hospitalized.   

Fax forms for claims to (907) 714-2384 or email to This email address is being protected from spambots. You need JavaScript enabled to view it.

 If you have questions or need assistance with the forms, please call the Risk Manager at (907) 714-2351 or the Safety Manager at (907) 714-2354

Workers Compensation Forms

Alaska Department of Labor Form - Report of Injury

Drivers Report of An Accident