WebYou can also fax the form to the number below: FAX (use for either office): (602) 542-3373. Enjuris tip: If you have general questions about filing your form, you can contact: [email protected] or (602) 542-4661 (Phoenix) or (520) 628-5181 (Tucson). Do NOT email your form to the email address listed above. Web20 jan. 2024 · Section R20-5-106 - Commission Forms A. The following forms shall be used when applicable: 1. Employer's report of industrial injury (form 101) shall contain: a. Employee, employer, and carrier identification; b. Description of employment; c. Description of accident and injury; d. Description of medical treatment received by employee; e.
Forms for appealing an Industrial Commission ruling
WebIndustrial Earn are Arizona . Protection of lives, health, safety, and welfare of Arizona's workforce . Follow Industrial Commission of Arizona on: Search. Main carte. Home; Agency Information. Over Us; Commissionaires; Director's Office; Legislation. Arizona Regulations; Zone Rules ... Forms. Forms Please Note ... WebWelcome to the Industrial Commission of Arizona Payment Portal. Please select the appropriate link at the top of the page to begin the payment process. Payment Portal users can make payments online 24/7 using one of the following payment methods. Visa Discover MasterCard American Express ACH (Electronic Check) finger dictionary
Section R20-5-106 - Commission Forms, Ariz. Admin. Code
WebForms Industrial Commission of Arizona Protection of life, health, safety, and welfare of Arizona's workforce Main menu Home Payment Portal OMBUDSMAN Home Online … • A medical provider or injured employee must submit a Request for … Worker’s Report of Injury Form: Request to Change Doctors Form: Request to … Worker’s Report of Injury Form: Request to Change Doctors Form: Request to … WebIndustrial Commission of Arizona. 800 West Washington Street Phoenix, AZ 85007 602-542-4661 Industrial Commission of Arizona. Workers' compensation insurance is … WebIndustrial Commission of Arizona . Protection of life, health, product, and welfare regarding Arizona's personnel . Follow Industrial Commission of Zone for: Hunt. Main choose. Home; Agency Information. About Us; Commissioners; Director's Office ... Unpaid Wage Claim Form. ertc short school