Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
Notice to Employees: Arizona Worker’s Compensation Law
Notice to Employees: Work Exposure to Bodily Fluids (HIV, AIDS, Hepatitis C) (Versión en Español)
Notice to Employees: Work Exposure to MRSA, Spinal Meningitis, or Tuberculosis (TB)
2026 Minimum Wage Poster (Versión en Español)
Earned Paid Sick Time Poster (Versión en Español)
Employee Safety and Health Protection Poster (Versión en Español)
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Report Forms
Notice of Web Form Version of Employers Report of Injury
ICA 2210 – Serious Event Reporting Form
Incident Investigation Report (Versión en Español)
Supervisor’s Report of Employee Incident (Versión en Español)
Witness Statement of Injury or Incident (Versión en Español)
Instructions for Injured Worker Handouts
Injured Workers First Fill Prescription Form (Versión en Español)
ICA 0407 – Workers’ Report of Injury (Versión en Español)
ICA 0124 – Report of Significant Work Exposure to Bodily Fluids or Other Infectious Material
Consent and Authorization for Release of Information Form (Versión en Español)
Request for Medical History Form (Versión en Español)
Direct Deposit Authorization Form (Versión en 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
