Utah State Government Forms

Form Title	Agency	Topics
001 Industrial Accident Claim – Form Instructions	Department of Labor Commission
001 Industrial Accident Claim – Form Instructions	Occupational Safety & Health
024 Medical Care Provider	Department of Labor Commission
024 Medical Care Provider	Occupational Safety & Health
025 Industrial Accident Claim	Department of Labor Commission
025 Industrial Accident Claim – Form Instructions	Occupational Safety & Health
026 Occupational Disease Claim – Form Instructions	Department of Labor Commission
026 Occupational Disease Claim – Form Instructions	Occupational Safety & Health
027 Occupational Disease Claim – Form Instructions	Department of Labor Commission
027 Occupational Disease Claim – Form Instructions	Occupational Safety & Health
1101: Manufacturing of Bedding/Upholstered Furniture Dealer	Conservation and Resource Management
1102: As a Wholesale Bedding/Upholstered Furniture Dealer	Conservation and Resource Management
1103: As a Upholstery Supply Dealer	Conservation and Resource Management
1104-1105: As a Upholsterer with Employees	Conservation and Resource Management
1106: As a Sterilizer of Filing Material	Conservation and Resource Management
1110: As a Manufacturer of Quilted Clothing	Conservation and Resource Management
113a Summary of Medical Record – Industrial Accident	Occupational Safety & Health
113a Summary of Medical Record – Industrial Accident (or you may submit actual medical records supporting your claim)	Department of Labor Commission
113b Summary of Medical Record – Occupational Exposure	Department of Labor Commission
113b Summary of Medical Record – Occupational Exposure	Occupational Safety & Health