Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
DWC Form WC-106 – Workers’ Compensation Law – Roles and Responsibilities for Employers and Employees (Versión en Español)
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Reports
DWC Form WC-1-EDI – Report of Injury
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)
DWC Form WC-280 – Report Your Workplace Injury, Occupational Disease, or Repetitive Trauma Injury
DWC Form WC-303 – Claimant Authorization to Disclose Worker’s Compensation Records
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
DWC Brochure WC-259 – Workers’ Compensation Requirements for the Missouri Construction Industry
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
Rejection of Coverage Form
