All Government Forms in Utah

Form Title	Agency	Jurisdiction
1110: As a Manufacturer of Quilted Clothing	Conservation and Resource Management	Utah
113a Summary of Medical Record – Industrial Accident	Occupational Safety & Health	Utah
113a Summary of Medical Record – Industrial Accident	Anti-Discrimination	Utah
113a Summary of Medical Record – Industrial Accident (or you may submit actual medical records supporting your claim)	Department of Labor Commission	Utah
113b Summary of Medical Record – Occupational Exposure	Department of Labor Commission	Utah
113b Summary of Medical Record – Occupational Exposure	Occupational Safety & Health	Utah
113b Summary of Medical Record – Occupational Exposure	Anti-Discrimination	Utah
1391 Instructions	Department of Transportation	Utah
1444 Instructions	Department of Transportation	Utah
152 Appointment of Counsel	Department of Labor Commission	Utah
152 Appointment of Counsel	Occupational Safety & Health	Utah
152 Appointment of Counsel	Anti-Discrimination	Utah
2018 Medical Fee Standards	Department of Labor Commission	Utah
2018 Workers’ Compensation Quick Reference Guide	Department of Labor Commission	Utah
2019 Medical Fee Standards	Department of Labor Commission	Utah
2019 Workers’ Compensation Payment Grid	Department of Labor Commission	Utah
2019 Workers’ Compensation Quick Reference Guide	Department of Labor Commission	Utah
2021-Negotiated-Agreement-Final	Utah Schools for the Deaf and Blind	Utah
307 Medical Treatment Provider List	Department of Labor Commission	Utah
307 Medical Treatment Provider List	Occupational Safety & Health	Utah