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Oregon Form Center


Welcome to the most extensive library of workers' compensation forms available anywhere. Almost 3,000 forms are available for your immediate download and use. Our forms, all of which have been custom programmed by WorkersCompensation.com for Type & Save functionality, are available for individual purchase below.

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(158) Corrections And Changes Notification - 8/05
(801) Report of Injury or Illness - 8/04
(801s) Reporte de Lesión o Enfermedad en el Trabajo - 11/04
(821) Guaranty Contract Between the insurer and the Department of Consumer & Business Services - 1/08
(824) Surety Bond - 1/05
(827) Worker's and Physician's Report for Workers' Compensation Claims - 12/05
(827s) Reporte del Trabajador y Médico para Reclamaciones de Compensación para Trabajadores - 12/05
(900) Workers' Compensation Payroll & Assessment Quarterly Report Retrospective Rating Plan - 5/08
(910) Premium Assessment Report - 7/05
(937) Workers’ Compensation Payroll & Assessment Quarterly Report Normal Plan - 5/08
(1081) Return-to-Work Plan; Training - 12/07
(1083) Return-to-Work Plan; Direct Employment - 12/07
(1084) Request for Administrative Approval (to be filed for reimbursable claims only - 12/07
(1174) Application for Approval of Lump-sum Payment of Award - 1/08
(1502) Insurer's Report - 7/97
(1503) Insurer Notice of Closure Summary - 4/03
(1592) Vocational Reimbursement Request (Required for pre-1986 injuries only) - 7/05
(1614) Report of Gross Annual Income - 1/08
(1644) Notice of Closure - 2/06
(1644c) Correcting Notice of Closure - 2/06
(1644d) Notice of Closure - 2/06
(1644p) Notice of Closure, Permanent Total Disability Reduction - 2/06
(1644r) Rescinding Notice of Closure - 2/06
(1644s) Aviso al Trabajador -- incluído con aviso de clausura (Notice of Closure) del asegurador (1644s) - 12/03
(1810) Surety Rider - 1/05
(1865) Endorsement to Include Legal Entity in Self-Insured Certification - 12/08
(1880) Vocational Assistance Certification Program Individual Certification under OAR 436-120 - 8/07
(1930) Preferred Worker Worksite Modification Agreement (Limited to $2,500) - 7/05
(1930a) Job Analysis for Worksite Modification, Preferred Worker Program, Attachment A - 3/02
(1966) Reopened Claims Reserve Reimbursement Request - 1/06
(2066) Notice of Closure: Own Motion Claim - 1/06
(2190) Preferred Worker Wage Subsidy Agreement - 12/07
(2223a) Worker Request for Reconsideration - 1/08
(2223a-s) Petición del Trabajador para Reconsideración - 9/08
(2223b) Insurer Request for Reconsideration - 1/08
(2278) Spinal Range of Motion - 3/00
(2279) Range of Motion and Deformity/Deviation; Amputation and Sensation of the Upper Extremity - 5/00
(2312) Visual Impairment - 9/97
(2330) Medical Fee Dispute Resolution Request form - 5/04
(2330a) Medical Fee Dispute Resolution Worksheet - 12/03
(2332) Worker's Request to Change Attending Physicians - 1/08
(2333) Insurer's Request for Director Approval of an Insurer Medical Examination - 8-07
(2350) Preferred Worker Obtained Employment Purchase Agreement - 12/07
(2350s) Acuerdo de Compra de Artículos Necesarios para el Empleo del Trabajador Preferido - 1/08
(2360) Employer-at-Injury Program (EAIP) Reimbursement Request Form (Effective December 1, 2007) - 12/07
(2465) Worker Leasing Notice to the Department of Consumer & Business Services - 6/09
(2466) Application for Worker Leasing Company License - 7/09
(2466a) Attachment A to Application for Worker Leasing Company License - 9/03
(2466b) Attachment B to Application for Worker Leasing Company License - 5/04
(2466c) Attachment C to Application for Worker Leasing Company License - 9/03
(2476) Request for Release of Medical Records for Oregon Workers' Compensation Claim - 3/99
(2476s) Solicitud para Divulgar Expedientes Médicos para Reclamación de Compensación para Trabajadores de Oregon - 2/05
(2800) Vocational Closure Report - 12/07
(2807) Insurer Notice of Closure Worksheet (Dates of injury prior to January 1, 2005) - 2/06
(2807a) Insurer Notice of Closure Worksheet (Dates of injury on or after January 1, 2005) - 2/06
(2808) Claim Reserve Worksheet - 1/09
(2809) Self-Insurer Report of Losses Experience Rating Period - 12/05
(2810) Self-insurer Report of Losses Non-Experience Rating Period - 8/07
(2814) Authorization of Vocational Assistance Provider - 12/99
(2839) Request for hearing - Workers' Compensation Division - 7/08
(2842) Request for Dispute Resolution Medical Issues and Medical Fees - 4/07
(2842a) Medical Fee Dispute Resolution Request and Worksheet - 4/07
(2882) Nurse Practitioner Statement - 9/08
(2937) Claims Reserved in Excess of Self-Insured Retention - 8/07
(2943) Worker Request for Claim Classification Review - 2/08
(2943s) Solicitud del Trabajador para Revisión de Clasificación de Reclamación - 7/08
(2968) Preferred Worker Program Wage Subsidy Reimbursement Request - 12/07
(2969) Preferred Worker Program Worksite Modification Agreement (for Employer at Injury - limited to $2,500) - 7/05
(2970) Preferred Worker Program Premium Exemption and Wage Subsidy Agreement (for Employer at Injury) - 12/07
(2971) Preferred Worker Program Obtained Employment Purchase Agreement (for Employer at Injury) - 12/07
(3014) Preferred Worker Program Quarterly Claim Cost Reimbursement Request - 12/07
(3058) Notice to Worker - 7/04
(3058s) Aviso al Trabajador - 9/04
(3088) Request for WCD claim file information - 8/09
(3093) Diskette Order Form; Oregon Workers' Compensation (Medical) Payments - 1/06
(3210) Medical forms order form - 4/07
(3215) Endorsement to Guaranty Contract - 3/04
(3216) Cancellation Notice - 3/04
(3217) Reinstatement of Guaranty Contract - 7/03
(3227) Invasive Medical Procedure Authorization (Autorización para Procedimiento Médico Invasivo) - 10/07
(3228) Elective Surgery Notification - 1/06
(3245) Release to Return to Work - 10/05
(3270) Endorsement to Worker Leasing Notice - 6/09
(3271) Termination of Workers' Compensation Coverage to client of worker leasing company - 6/09
(3283) Understanding workers' compensation claims - 1/07
(3283s) Entendiendo las Reclamaciones de Compensación para Trabajadores - 1/07
(3285) Request For Reimbursement From The Retroactive Program - 9/06
(3289) Analysis of upper extremity use for office activities - 3/01
(3292) Workers' Compensation Division (WCD) Subscription Service - 5/09
(3293) Preferred Worker Program Obtained Employment Purchase Agreement Moving Assistance - 12/07
(3297) Preferred Worker Program Substantial Modification Determination - 11/01
(3299) Worker Requested Medical Examination Statement of Interest - 4/02
(3501) Notice of Voluntary Reopening Own Motion Claim - 1/06
(3504) Supplemental Disability Benefits Quarterly Reimbursement Request - 8/02
(3506) Request for workers' compensation claims history information or service - 9/09
(3529) Memorandum of Understanding - 7/03
(3530) Supplemental Disability Election Notification - 1/05
(3531) Physician Authorization Supplemental Disability - 9/03
(3650) Physician Assistant’s Statement of Certification - 7/07
(3640) Irrevocable Standby Letter of Credit - 7/03
(3640a) Irrevocable Standby Letter Of Credit (Form A) - 8/06
(3640b) Irrevocable Standby Letter Of Credit (Form B) - 8/06
(3648) Chiropractor’s Statement of Certification - 7/07
(3649) Podiatrist’s Statement of Certification - 7/07
(3651) Naturopath’s Statement of Certification - 7/07
(3659) Fee Discount Agreement - 12/08
(3921) Request for Reimbursement of Expenses - 9/09
(3921s) Solicitud para reembolso de gastos - 9/09
(3930) Application for Independent Medical Exam Medical Service Provider Authorization - 6/07
(4023) Security Agreement and Notice to Intermediary - 10/03
(4122) Preferred Worker Employment Purchase Agreement (Worksite creation) - 12/07
(4123) Preferred Worker Employment Purchase Agreement (Miscellaneous purchases) - 12/07
(4619) Request for Approval of Training Program - 10/03
(4819) Trading Partner Agreement Filing Guaranty Contracts Through Electronic Data Interchange 8/08
(4820) Trading Partner Agreement Filing Guaranty Contracts Through Electronic Data Interchange after July 1, 2009 - 8/08
(4821) Oregon Proof of Coverage EDI Insurer Profile 8/08
(differed) Injured Worker/Representative Responsible To Assist In Investigation; Suspension Of Compensation And Notice To Worker - 1/06
(injprac) Insanitary Or Injurious Practices, Refusal Of Treatment Or Failure To Participate In Rehabilitation - 1/06
(missime) Failure To Attend Or To Cooperate With An Ime - 1/06
(cdaformat2) Claim Disposition Agreement - N/D
(costform) Cost Bill Form - N/D
(omrecommedation2006b) Carrier's Own Motion Recommendation - 1/06
(postcardpac2) Claims Disposition Agreement (CDA) Postcard - N/D
(req4h410-05) Request for Hearing and Specification of Issues - 10/05
(reqbdreview) Request For Board Review - 4/06
(subpoena1) SUBPOENA To Compel Attendance and Testimony at Hearing - N/D
(subpoena2) SUBPOENA To Compel the Production of Documents or Objects other than Individually Identifiable Health Information - N/D
(subpoena3) SUBPOENA To Compel the Production of Individually Identifiable Health Information - N/D