Forms/Checklists
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Accident Investigation Form
Accident Investigation Kit – Spanish
Accident Reporting Checklist
AZ Minimum Wage Act Poster – Spanish
Claim Form – Oregon – Spanish
Computer Workstation Ergonomics Self-Assessment Checklist
Construction Site Hazard Assessment
Developing a Safety Program
DOWC Insurance Requirements Brochure – Colorado
Driver Vehicle Safety Inspection Checklist
Driver Vehicle Safety Inspection Checklist (Word Version)
Driving – Motor Vehicle Accident Investigation Form
Employee Safety and Health Protection – Arizona
Employee’s Claim for Workers’ Compensation Benefits DWC-1
Employers Report of Industrial Injury Form ICA-04-0101
Employers Report of Injury – Colorado
Employers Report of Injury – Nevada
Employers Report of Injury – Oregon
Employers Report of Injury – Utah
Ergonomics Assessment – Sit/Stand- First Report of Injury Form 5020
First-Aid Checklist
First-Aid Supplies Approval Form
Healthcare Inspection Checklist Administration
Healthcare Inspection Checklist Dietary
Healthcare Inspection Checklist Housekeeping
Healthcare Inspection Checklist Maintenance
Healthcare Inspection Checklist Nursing Station
Healthcare Inspection Checklist Security
Hospitality Inspection Checklist
Housekeeping Checklist
IIPP Assessment Tool
IIPP Self Audit
Individual Safety Training Form
Information for Employers for Workers’ Compensation – Nevada
Information for Injured Workers – Nevada
Information for Injured Workers – CO (Spanish)
Knife Safety Checklist
Medical Service Order form California
Medical Services Order Form – Not California- Medical Services Order Form – Not California
Minimum Wage Act Poster
MPN Distribution Acknowledgement
Needlestick Protocol Checklist
Nevada Alternate Choice of Physician
Nevada ER Wage Verification Form
Nevada Fatality Report
Nevada Notice to Employees
New Hire Orientation Checklist
Notice of Injury or Occupational Disease – Nevada
Notice to Employees – Arizona
Notice to Employees Poster for Injuries Cause on the Job (DWC 7)
Office Ergonomics: Workstation Evaluation
Office Safety
OSHA Recordkeeping – Is it Recordable?
PPE Hazard Assessment Risk Analysis (Editable Form)
PPE Training Certification
Restaurant Safety Inspection Checklist
Safety Inspection Checklist
Safety Meeting Record
Supported Scaffolds Checklist
Supported Scaffolds Checklist – Spanish
TeleCompCare® Wallet Card Sample
TeleCompCare® Wallet Card Sample – Spanish
Time of Hire Pamphlet – English
Time of Hire Pamphlet – Spanish
Tractor Driver Safety Orientation Checklist
WalkSafe: Accident Investigation Report Form
Work Exposure to Bodily Fluids – Arizona
Work Exposure to MRSA – Arizona
Workers Report of Injury – Arizona
Workers’ Compensation Temporary Prescription ID Card
