Workers Compensation

100 Empire Drive, Suite 100, St. Paul, MN 55103-1885 • Phone: (866) 547-6516

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Workers' Compensation - Forms

First Report of Injury

Submit Online:
File Your Report Here

Submit by Fax or Mail:
Download as a PDF

Please do not send the First Report of Injury by email. This is not a secure method for the information contained in this report.

Accident Report

Submit by Email, Fax or Mail
Download as a PDF
Download in Word

Payroll Estimate

Submit Online:
File Your Estimate Here

Pre-Injury Wage Form

Submit by Email, Fax or Mail
Download in Excel

For help completing these forms please see our Workers' Compensation Claim Reporting Guide. For help identifying appropriate Workers' Compensation Classification Codes for employees, see our Classification Codes Handbook.

Note: To view these forms you will need the Adobe Acrobat Reader plug-in or Microsoft Word installed on your computer. The Reader can be downloaded at no cost from Adobe's website.