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RI Workers' Compensation Forms: Compliance Forms

List compliance forms in order by form title.
List compliance forms in order by form number.

  

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Compliance Forms by Form Title Right click on a form to save a copy on your PC.
Form Title Form Number       Revised Purpose PDF Fill-in Form
Election by Exempt Corporate Officer to Become Subject to Workers' Compensation DWC-11C 01/02 Purpose DWC-11C
Insurance Coverage Certification for Temporary Employment and Employee Leasing Companies DWC-09 11/05 Purpose DWC-09
Notice of Claim of Common Law Rights DWC-11 01/02 Purpose DWC-11
Notice of Designation as an Independent Contractor DWC-11-IC 3/06 Purpose DWC-11-IC Also in Excel format
Notice of Insurance Policy Change Electronic 4/99 Purpose Not Available  
Notice of Withdrawal of Designation as Independent Contractor DWC-11-ICR 03/06 Purpose DWC-11-ICR Also in Excel format
Rescind Notice of Claim of Common Law Rights DWC-11R 01/02 Purpose DWC-11R
WC Act Summary Poster (English) DWC-08 05/04 Purpose DWC-08
WC Act Summary Poster (Spanish) DWC-08S 05/04 Purpose DWC-08S
Compliance Forms by Form Number Right click on a form to save a copy on your PC.
Form Title Number Revised Purpose PDF Fill-in Form    
WC Act Summary Poster (English) DWC-08 05/04 Purpose DWC-08
WC Act Summary Poster (Spanish) DWC-08S 05/04 Purpose DWC-08S
Insurance Coverage Certification for Temporary Employment and Employee Leasing Companies DWC-09 11/05 Purpose DWC-09
Notice of Claim of Common Law Rights DWC-11 01/02 Purpose DWC-11
Election by Exempt Corporate Officer to Become Subject to Workers' Compensation DWC-11C 01/02 Purpose DWC-11C
Notice of Designation as an Independent Contractor DWC-11-IC 3/06 Purpose DWC-11-IC Also in Excel format
Notice of Withdrawal of Designation as Independent Contractor DWC-11-ICR 3/06 Purpose DWC-11-ICR Also in Excel format
Rescind Notice of Claim of Common Law Rights DWC-11R 01/02 Purpose DWC-11R
Notice of Insurance Policy Change Electronic     4/99 Purpose Not Available  
 

For information about independent contractor forms, please contact the Fraud and Compliance Unit at (401) 462-8100 option 5 or wcfraud@dlt.ri.gov

For information about Notice of Claim of Common Law Rights, Election of Exempt Corporate Officer, or Rescind Notice of Claim, please contact the Fraud and Compliance Unit at (401) 462-8100 option 4 or wcfraud@dlt.ri.gov.

For information on the other forms, please contact the WC Education Unit at (401) 462-8100 option 1 or WCEdcUnit@dlt.ri.gov.

For information on workers' compensation, please contact the Information Line at (401) 462-8100 option 1, or WCEdcUnit@dlt.ri.gov

To comment on this site, please contact the WC web staff at (401) 462-8023 or WCWebmaster@dlt.ri.gov

This page was last updated on 11/15/06. 

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