Forms

Visitor/Client Incident/Accident Analysis Form (DA 3000)

Sample Safety Inspection Checklist

Hazard Control Log

Driver Authorization Form (DA 2054)

Contractor Driver Authorization Form (DA 2055)

Vehicle Checklist (DA 424)

General Liability Loss Notice (DA 2065)

Water Vessel Authorization Form (DA 2066)

Water Vessel Operator Record Request Form

Safety Meeting Form

UND 4.1 - New Building, Contents and Other Insured Property

UND 4.2 - Building Deletion

UND 4.3 - Building Modification

 

Transitional Return to Work Audit Form

Physician's Modified Work Information Sheet

Transitional Return to Work Flowchart

Acknowledgement of Non-State Employees Using State Vehicles

• W9 Form
• Attorney Billing Guidelines
• Billing Affidavit
• Initial Case Assessment (non-Workers Comp)
• Initial Case Assessment (Workers Comp only)
• Six-Month Case Assessment (non-Workers Comp)
• Six-Month Case Assessment (Workers Comp only)
• Status Update Form
• Request for Contract Expert/Consulting Services
• Request for Writ or Appeal
• Request for Settlement Authority (non-Workers Comp)
• Request for Settlement Authority (Workers Comp only)
• Notice of Case Closure