Forms & Reports

• Forms
• Research
• Accountability
• Looking Ahead

Hearing Loss - When filing for a Hearing loss claim please make sure you fill out the following 3 forms:

   Worker's Report of Injury/Illness- You only need to complete sections "Tell us about You" and "About your information"

Worker Report: Employment Record

                                                                                                                                                          Worker Report: Background Information

                                                                                                                                                           

                                                                                                                                                           

For Service Providers, please use the following forms below:

Assistive Listening Device Request 

Hearing Aid Replacement

Service Provider Report