Workers' Compensation Employer Forms, Rhode Island Department of Labor and Training

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