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

File a Claim
Rehabilitative Services
Report Uninsured Employers
Report Fraud
Independent Contractor Seach and Online Filing
Find Medical Fees
Find Hospital Rates

Become an Adjuster
Find Info Letters

Employer Forms

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Automatic Calculation Wage Statements in Excel

Table is sortable by column

Click HERE for Electronic Filing of First Reports

Form Title
Form Number
Formats Available
First Report of Injury
Employer: Report Injury to Your Insurer
Employers must report injuries directly to their workers’ compensation insurance companies.  Insurers must report electronically to State of RI via EDI
Employee's Objection to Wage Transcript
Wage Statement: Full Time
Wage Statement: Part Time
Wage Statement: Seasonal
Employee's Certificate of Dependency Status
Notice of Claim of Common Law Rights (Waiver)
Not Available
Notice of Designation as an Independent Contractor
Not Available
Notice of Insurance Policy Change
Electronic Submission Only
Contact NCCI
Notice of Withdrawal of Designation as Independent Contractor
Not Available
Rescind Notice of Claim of Common Law Rights
Not Available
WC Act Summary Poster (English)
Not Available
Not Available
Election by Exempt Corporate Officer to Become Subject to Workers' Compensation
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
7/24/15 MDF
State Seal
  DLT is an equal opportunity employer/program. Auxiliary aids and services available upon request