Employer Resource Library

Arizona Employer Resource Guide

Cover Sheet and Welcome Letter

Table of Contents

Instructions for Posters

Notice to Employees: Arizona Workers’ Compensation Law

Notice to Employees: Work Exposure to Bodily Fluids (HIV, AIDS, Hepatitis C) (Español)

Notice to Employees: Work Exposure to MRSA, Spinal Meningitis, or Tuberculosis (TB)

2020 Minimum Wage Poster (Español)

Earned Paid Sick Time Poster (Español)

Employee Safety and Health Protection Poster (Español)

Fraud Prevention Poster (Español)

Instructions for Injury Report Forms

ICA 04‐0101 ‐ Employer’s Report of Industrial Injury

ICA 2212 – Serious Event Reporting Form

Incident Investigation Form (Español)

Supervisor’s Report of Employee Incident (Español)

Witness Statement of Injury or Incident (Español)

Instructions for Injured Worker Handouts

ICA 0407 ‐ Workers’ Report of Injury

ICA 0124 – Report of Significant Work Exposure to Bodily Fluids or Other Infectious Material

Consent and Authorization for Release of Information Form (Español)

Request for Medical History Form (Español)

Instructions for Informational Documents

Omaha National Contact Information

Reduce Your Workers Compensation Costs

Significant Exposure Under the Arizona Workers’ Compensation Act

Instructions for General Forms

Request for Subrogation Waiver

Form ERM-14 – Confidential Request for Ownership Information

Company Contacts Verification

Instructions for State-Specific Forms & Documents

ICA 0113 – Employee’s Notice of Rejection of Terms of the Arizona Workers’ Compensation Law

ICA 0114 – Employee’s Notice to Revoke Rejection of Terms of the Arizona Workers’ Compensation Law