Workers' Compensation, Rhode Island Department of Labor and Training


Employer Forms

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Automatic Calculation Wage Statements in Excel


Table is sortable by column

 

Form Title
Form Number
Date Revised
Purpose
Instruction
PDF
Excel
Employer's First Report of Alleged Occupational Injury or Disease
DWC-01
01/03
Instructions DWC-01
Employee's Objection to Wage Transcript
DWC-31
01/03
Instructions Not available
Wage Statement: Full Time
DWC-03F
01/03
Instructions | Tips DWC-03F
Wage Statement: Part Time
DWC-03P
01/03
Instructions | Tips DWC-03P
Wage Statement: Seasonal
DWC-03S
01/03
Instructions | Tips DWC-03S
Employee's Certificate of Dependency Status
DWC-04
01/03
Not available Not available
Election by Exempt Corporate Officer to Become Subject to Workers' Compensation
DWC-11C
04/05
Not available Not available
Notice of Claim of Common Law Rights (Waiver)
DWC-11
01/03
Not available Not available
Notice of Designation as an Independent Contractor
DWC-11-IC
01/03
Not available DWS-11-IC
Notice of Insurance Policy Change
Electronic
4-99
Not available
Not available
Not available
Notice of Withdrawal of Designation as Independent Contractor
DWC-11-ICR
01/03
Not available DWC-11-ICR
Rescind Notice of Claim of Common Law Rights
DWC-11R
01/03
Not available Not available
WC Act Summary Poster (English)
DWC-08
01/03
Not available Not available
WC Act Summary Poster (Spanish)
DWC-08S
01/03
Not available Not available

 

 




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Rhode Island Department of Labor and Training
Division of Workers' Compensation
1511 Pontiac Avenue, Building 71-1, First Floor, PO Box 20190, Cranston RI 02920-0942
Email: WCEdcUnit@dlt.ri.gov | Phone: (401) 462-8100 | TDD:(401) 462-8006

Sandra M. Powell, Director


updated: July 16, 2008