Workers' Compensation, RI Dept. of Labor and Training
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Find Coverage

File a Claim
Rehabilitative Services
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Report Fraud
Independent Contractor Seach and Online Filing
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Become an Adjuster
Find Info Letters


Employer Forms

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Automatic Calculation Wage Statements in Excel

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NOTE: Please fax your first reports of injury to (401) 462-8105.


Form Title
Form Number
Formats Available
Instructions
DWC-01
DWC-31
DWC-03F
DWC-03P
DWC-03S
DWC-04
DWC-11
Not Available
DWC-11-IC
Not Available
PC1 PC2
Electronic Submission Only
Contact NCCI
DWC-11-ICR
Not Available
DWC-11R
Not Available
DWC-08
Not Available
DWC-08S
Not Available
Election by Exempt Corporate Officer to Become Subject to Workers' Compensation
DWC-11C
Not Available,
call (401) 462-8100 option 7 for information.
Self Insurance Forms      
Application for Approval of Workers' Comp Self-Insurance Program RI SI-2 PDF Not Available
Self-Insurance Agreement RI SI-17 PDF Not Available


 
RI Department of Labor and Training
Workers' Compensation
Center General Complex
1511 Pontiac Avenue, Cranston, RI 02920


Phone: (401) 462-8100
Fax (401) 462-8105
TTY via RI Relay: 711
7/29/14 MDF
State Seal
  DLT is an equal opportunity employer/program. Auxiliary aids and services available upon request