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Virginia 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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(1sp) Noticia Sobre Compensación Laboral - N/D
(3) Employer's First Report of Accident - 3/02; Instructions - 9/07
Requires tan paper
(post3) First Report of Injury (Post 10/1/2008 accidents)
(3a) Supplementary Report - 9/07
Any white paper
(3b) Supplementary Report for Fatal Accidents - N/D
Any white paper
(4) Agreement to Pay Benefits - 9/07
Requires green paper
(post4) Award Agreement (Post 10/1/2008 accidents)
(4a) Supplemental Agreement to Pay Benefits - 9/07
Requires green paper
(4g) Supplemental Agreement to Pay Varying Temporary Partial Benefits - 9/07
Requires green paper
(5) Initial Claim for Workers' Compensation Benefits - 9/00
Preferably blue paper
(post5) Claim Form & Request for Hearing (Post 10/1/2008 accidents)
(5a) Employer's Application for Hearing - 9/07
Requires blue paper
(6) Physician's Report - 9/07
Any white paper
(7a) Wage Chart - 9/07
Any white paper
(9a) Waiver of Occupational Disease Coverage 10/91
Any white paper
(12a) Lump Sum Agreement
Any white paper
(16a) Rejection of Coverage - 1/99
Any white paper
(17a) Notice Terminating Prior Rejection of Coverage
Any white paper
(22) Parental Guarantee 10/91
(35) Memorandum of Agreement for Payment of Compensation in a Fatal Case - 9/07
Any white paper
(post35) Fatal Award Agreement (Post 10/1/2008 accidents)
(45a) Report of Minor Injuries 9/07
Any white paper
(45g) Report of Medical Costs - 9/07
Any white paper
(45h) Notice Of Cancellation Or Non-Renewal 7/04
Any white paper
(45h-gsia) Notice of Change, Cancellation or Non-Renewal 7/04
Any white paper
(46) Termination of Wage Loss Award - 9/07
Requires buff paper
(post46) Termination of Wage Loss Award (Post 10/1/2008 accidents)
(50) Request for Peer Review
Any white paper
(51) Overview of the Peer Review Program
Any white paper
(61a) Contractor's Certification of Insuring Liability for Workers' Compensation in Virginia 7/02
Any white paper
(requestmediation) Request for Mediation
Any white paper
(req4hearing) Request for Expedited Hearing - N/D
Any white paper
(siapplication) Application for Self-Insurance
Any white paper
(vwc1) Employer's Workplace Notice
Any white paper
(subpoena duces tecum) Subpoena Duces Tecum - N/D
Any white paper
(ADPA2) Subpoena Duces Tecum (Civil) - N/D
(subp depos) Subpoena For The Taking Of Deposition - N/D
(subpductec req party) Subpoena Duces Tecum for Required Third Party - N/D
(wit subpoena) Subpoena For Witness - N/D
(witn atty) Subpoena For Witness (Civil) - N/D
(sheriff ltr) Sheriff's Subpoena Letter - N/D
(amputation foot) Amputation Foot - Chart - 10/91
(amputation hand) Amputation Hand - Chart - 10/91
(ca51) US Social Security Administration - Benefits - 7/06
(CoalMinesNotice) Coal Mines Notice - 3/06
(loc) Irrevocable Letter of Credit - 10/04
(medrequest) Request for Mediation - 9/07
(SIbond) Affidavit and Acknowledgment of Surety - N/D