Utah State Government Forms

1 - 20 of 1864 forms

Form Title Agency Topics
001 Industrial Accident Claim – Form Instructions Department of Labor Commission
024 Medical Care Provider Department of Labor Commission
025 Industrial Accident Claim Department of Labor Commission
026 Occupational Disease Claim – Form Instructions Department of Labor Commission
027 Occupational Disease Claim – Form Instructions Department of Labor Commission
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
1391 Instructions Department of Transportation Construction, Appendix / Toolbox, Appendix / Toolbox
1444 Instructions Department of Transportation Construction, Appendix / Toolbox, Appendix / Toolbox
152 Appointment of Counsel Department of Labor Commission
2018 Medical Fee Standards Department of Labor Commission
2018 Workers’ Compensation Quick Reference Guide Department of Labor Commission
2019 Medical Fee Standards Department of Labor Commission
2019 Workers’ Compensation Payment Grid Department of Labor Commission
2019 Workers’ Compensation Quick Reference Guide Department of Labor Commission
307 Medical Treatment Provider List Department of Labor Commission
308 Authorization to Release Medical Records Department of Labor Commission
30 Day ATMS BURN-IN TEST REPORT Department of Transportation Construction, Inspection
402 Application for Hearing – Termination or Reduction of Compensation Department of Labor Commission
403 Persons with Knowledge List Department of Labor Commission